A case of Testicular Cyst

Case Presentation: Scrotal Ultrasound in a 69-Year-Old Male with Chronic Comorbidities

Introduction Scrotal swelling is a common presentation in urology and general practice, often requiring imaging for accurate diagnosis. This case discusses a 69-year-old male with a history of diabetes mellitus (DM) and hypertension (HTN) who presented with progressive right scrotal swelling, resistant to antibiotic therapy.

Testicular cyst

Case Details

Patient History: A 69-year-old male with a 10-year history of DM and HTN, managed with metformin (500mg BD) and amlodipine (10mg OD), presented with a one-month history of progressive right scrotal swelling. He also reported symptoms of polyuria and polydipsia. Despite multiple courses of antibiotics for suspected epididymal-orchitis, there was no improvement.

Physical Examination:

• General Condition: Fair, with mild pallor and no jaundice.

• Vital Signs:

  • Blood Pressure: 162/83 mmHg

  • Pulse Rate: 100 bpm

  • Oxygen Saturation (SpO2): 97% on room air

• Local Examination:

  • Right Testicle: Swollen, warm, tender, with fluctuation but no obvious masses.

  • Left Testicle: Normal in size, shape, and color, non-tender.

  • Hernial Orifices: Free.

Given the chronicity of symptoms and lack of response to antibiotics, a scrotal ultrasound was requested.

Scrotal Ultrasound Findings

Right Hemi-scrotum:

• Well-defined anechoic lesion with a thin wall in the right testis measuring 0.96 x 0.74 x 0.72 cm (volume: 0.26 cm³) consistent with a testicular cyst.

• Right testis was normal in size and shape (3.49 x 2.50 cm) with preserved vascularity on color Doppler.

• Significant anechoic free fluid collection within the tunica vaginalis measuring 2.55 cm, consistent with a moderate hydrocele.

• Pampiniform plexus vessels appeared normal.

• Scrotal wall thickness was within normal limits.

• No inguinal hernia or lymphadenopathy detected.

Left Hemi-scrotum:

• Normal testis in size, shape, and echo pattern (4.26 x 2.65 cm), with preserved vascularity on color Doppler.

• No intra-testicular or extra-testicular masses.

• Normal epididymis with preserved echotexture and vascularity.

• No significant free fluid collection.

• Pampiniform plexus vessels were normal.

• Scrotal wall thickness was normal.

• Inguinal canal was closed.

Conclusion:

1. A Small Right Testicular Cyst

2. Right Moderate Hydrocele

Discussion and Clinical Significance

Testicular Cyst: Testicular cysts are benign, fluid-filled structures commonly found incidentally on scrotal imaging. They typically do not require intervention unless symptomatic. In this case, the cyst was small and unlikely to be the primary cause of the patient’s symptoms.

Hydrocele: A hydrocele represents an abnormal fluid accumulation within the tunica vaginalis. While small hydroceles are often asymptomatic, larger ones may cause discomfort and swelling, prompting medical attention. In this patient, the moderate hydrocele may explain the progressive scrotal swelling.

Management Considerations:

• Conservative Management: Small, asymptomatic hydroceles may be observed with regular follow-ups.

• Surgical Intervention: Large or symptomatic hydroceles may require surgical drainage or hydrocelectomy.

• Diabetes Control: Given the patient’s polyuria and polydipsia, optimizing glycemic control is crucial to reduce the risk of infections and poor wound healing in case of surgery.

• Hypertension Management: The patient's elevated BP (162/83 mmHg) may require medication adjustment to optimize cardiovascular health.

Conclusion This case highlights the importance of scrotal ultrasound in evaluating persistent scrotal swelling. In an elderly patient with chronic conditions, differentiating between infectious, inflammatory, and structural causes is crucial for appropriate management. The findings of a testicular cyst and hydrocele guide conservative monitoring versus potential surgical intervention based on symptom progression.

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