Hematocele of the spermatic cord is seen rarely. Recently, we have encountered a case of a 71-year-old male, who suddenly had a painful swelling in the left inguinal region and it was diagnosed as hematocele of the spermatic cord. Preoperative diagnosis is not common; it mimics a tumor and is usually present as operative or histological surprises.

1. Hematocele of the spermatic cord – A case report

2. Case Report
Hematocele of the spermatic cord – A case report
Gite Vandana *, Dhakane Maruti
Apollo Hospitals, Bilaspur, India
1. Introduction
Thecommonpathologicallesionsseeninthespermaticcordare
torsion, varicocele, funiculocele, etc. Hydrocele of the testis and
spermatic cord is a common disease with the highest incidence
commonly encountered among patients with inguinal region
swelling. Hematocele of the spermatic cord is seen rarely.
Preoperative diagnosis is not common; it mimics a tumor and is
usually present as operative or histological surprises.
2. Case report
A 71-year-old, male patient, with a known case of diabetes,
hypertension, and coronary artery disease (POST OP CABG)
came with complaints of swelling present over left inguinal
region since 7 days associated with pain. The patient had no
history of fever, vomiting, or trauma. He is on regular
medication of oral antidiabetic, angiotensin-converting-
enzyme (ACE) inhibitor, angiotensin II receptor antagonists,
beta-1 receptor antagonists, HMG CoA reductase inhibitors, and
cyclooxygenase inhibitors. Radiological investigations showed
fairly nodular lesion. Fine needle aspiration yielded blood with
macrophages and few inflammatory cells. Then the patient
underwent excision of lump with left sided orchidectomy.
Gross examination revealed left orchidectomy specimen
including testis (4 Â 2.5 Â 3 cm), epididymis (0.8 Â 2.5 Â 1 cm),
and spermatic cord 12 cm in length. The spermatic cord shows
cystic mass measuring 5.5 Â 3.5 Â 3 cm, covered by thick
capsule, congested, and filled with blood clots (Fig. 1). Testis
covered with tunica show smooth outer surface and unre-
markable parenchyma. The epididymis was unremarkable.
Histological examination shows that the wall of the cyst
consisted of edematous connective tissue with congested
dilated vessels, hemorrhage, and cellular infiltration (Fig. 2).
3. Discussion
Among the diseases that cause painful swelling in the inguinal
region, mention may be made of orchitis, torsion of the testis
a p o l l o m e d i c i n e x x x ( 2 0 1 5 ) x x x – x x x
* Corresponding author at: Associate Consultant, Department of Lab Services, Apollo Hospitals, Bilaspur CG, India.
Tel.: +91 09755040727/09893542691.
E-mail address: vandanagite@gmail.com (G. Vandana).
a r t i c l e i n f o
Article history:
Received 15 July 2015
Accepted 24 August 2015
Available online xxx
Keywords:
Spermatic cord
Hematocele
Painful swelling
a b s t r a c t
Hematocele of the spermatic cord is seen rarely. Recently, we have encountered a case of a
71-year-old male, who suddenly had a painful swelling in the left inguinal region and it was
diagnosed as hematocele of the spermatic cord. Preoperative diagnosis is not common; it
mimics a tumor and is usually present as operative or histological surprises.
# 2015 Indraprastha Medical Corporation Ltd. Published by Elsevier B.V. All rights
reserved.
APME-318; No. of Pages 2
Please cite this article in press as: Vandana G, Maruti D. Hematocele of the spermatic cord – A case report, Apollo Med. (2015), http://dx.doi.
org/10.1016/j.apme.2015.08.003
Available online at www.sciencedirect.com
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0976-0016/# 2015 Indraprastha Medical Corporation Ltd. Published by Elsevier B.V. All rights reserved.

3. and appendix testis, epididymitis, spermatoinvasion, intras-
crotal tumor, and trauma. Unique spermatic cord hematoma
has rarely been documented. The etiology may be idiopathic,
traumatic, secondary to anticoagulation therapy, or as an
extension of a retroperitoneal hemorrhage. It may be
misdiagnosed as an incarcerated inguinal hernia, a testicular
torsion, or a tumor. When the clinical features mentioned
above are present, ultrasonography with Doppler modes
should be routinely employed to confirm the diagnosis.
Chin1
and Bowman2
reported two cases of the spontaneous
idiopathic spermatic cord hematoma suggesting the possible
etiologies of spermatic cord vein rupture and tear in the
cremasteric muscle. Among traumatic conditions, Gordon
et al.3
presented a case of a varicocele ruptured following blunt
abdominal trauma with a sudden increase in intra-abdominal
pressure with transmission to the varicocele. Hemorrhage
secondary to a varicocele, however, is a known but rare
morbidity. Spermatic cord hematoma is also a rare complica-
tion of Henoch–Schönlein syndrome (HSS).4
So to conclude, spermatic cord hematocele constitutes a
very rare case and it could result probably from the lacerations
of the spermatic veins and secondary to anticoagulation
therapy.
Author contribution
Gite Vandana, Dhakane Maruti: The acquisition and interpre-
tation of data for the work, drafting the work, approval of the
version to be published and agree to be accountable for all
aspects of the work.
Conflicts of interest
The authors have none to declare.
r e f e r e n c e s
1. Chin W, Cadogan M, Wan R, Harrison L. Spontaneous rupture
of varicocele. West Indian Med J. 2009;58(2009):488–489.
2. Bowman J, Anton M. Spermatic cord hematoma in a
collegiate football player: a case report. J Athl Train.
1998;33:65–68.
3. Gordon J, Aldoroty R, Stone N. A spermatic cord hematoma
secondary to rupture from blunt abdominal trauma: a case
report and review. J Urol. 1993;149:602–603.
4. Eyal I, Mizrachi S, Greif Z. Spermatic cord hematoma
simulating torsion of testis in Henoch-Schönlein syndrome.
Harefuah. 1989;116(5):260–261.
Fig. 1 – Gross pathology
Fig. 2 – Histopathology.
a p o l l o m e d i c i n e x x x ( 2 0 1 5 ) x x x – x x x2
APME-318; No. of Pages 2
Please cite this article in press as: Vandana G, Maruti D. Hematocele of the spermatic cord – A case report, Apollo Med. (2015), http://dx.doi.
org/10.1016/j.apme.2015.08.003