Images in Clinical Medicine

Testicular Torsion in a Hydrocele

Eda Okatan, M.D., and Richard Keijzer, M.D., Ph.D.

N Engl J Med 2009; 361:698August 13, 2009

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Article

A 6-week-old male infant with congenital bilateral hydroceles presented with a reddish, painful, and swollen left scrotum of 2 days' duration. There were no signs of inguinal hernia or fever. A flashlight test revealed transillumination of a right hydrocele and opacity of the left scrotum. Ultrasonography revealed a 1.0-cm³ testis on the right side and a 1.45-cm³ testis on the left with associated scrotal edema. Doppler studies revealed obstruction of blood flow to the left testicle. These findings confirmed the diagnosis of left-sided testicular torsion. Surgical exploration revealed the left testicle to be necrotic; unilateral orchidectomy was performed. The infant was discharged 1 day after surgery. The postoperative course was uneventful, and the hydroceles had not recurred at 1-year follow-up. Congenital hydroceles are common, and most resolve spontaneously within a year; testicular torsion is an uncommon but serious complication.

Eda Okatan, M.D.
Richard Keijzer, M.D., Ph.D.
Erasmus Medical Center, Rotterdam 3000 CB, the Netherlands
richardkeijzer@gmail.com