Skrotal Hematosel ve Hidrosel Ayırımında Ultrasonografik Septasyonun Tanısal Değeri: Tek Merkezli, Retrospektif Bir Çalışma

Year 2024, , 93 - 98, 30.08.2024

Reşad Beyoğlu , Ramazan Serdar Arslan , Murat Seyit , Mert Özen

https://doi.org/10.30565/medalanya.1428943

Abstract

Amaç: Skrotum ve testisler yüzeysel organlar olduğundan dolayı palpasyonla ve bazen de transillüminasyonla kolaylıkla incelenebilir. Ancak bu yöntemlerle skrotumdaki sıvının hidrosel mi yoksa hematosel mi olduğunu ayırt etmek mümkün değildir. Bu çalışma, her hekimin tanıyabileceği basit bir bulguya (septasyon) dayanarak hematosel ve hidrosel arasındaki ultrasonografik ayrımı bulmaya çalışmaktadır.

Yöntem: Acil servise (AS) skrotal ağrı, şişlik veya kızarıklık şikayeti ile başvuran hastalar, şikayetleri travmaya bağlı ve şikayetleri spontan olarak gelişenler olmak üzere iki gruba ayrıldı. Çalışmaya dahil edilen tüm hastalara US/ Doppler eğitimini almış bir acil tıp uzmanı tarafından skrotal US/Doppler yapıldı.

Bulgular: Çalışmaya dahil edilen 61 hastanın 36'sı (%59) skrotal travma, 25'i (%41) ise travma dışı şikayetlerle başvurdu. Travma öyküsü olan 36 hastanın 8'inde (%22,2) hematosel, 1'inde (%2,8) hidrosel saptanırken, 27'sinde (%75) ne hematosel ne de hidrosel saptandı. Sekiz hematosel hastasının 6'sında (%75) septasyon saptanırken, 2'sinde (%25) septasyon saptanmadı (p=0,013). Öte yandan; skrotal travma nedeniyle başvuran ve hematosel bulgusu olmayan 28 hastanın hiçbirinde septasyon bulgusu rastlanmadı. Skrotal travma öyküsü olan hastalar, süreye göre gruplandırıldığında, akut veya 1 hafta içinde skrotal travma geçiren 12 hastanın hiçbirinde septasyon bulgusu rastlanmamışken, 1-4 hafta önce travma geçiren 24 hastanın 6’sında (%25) septasyon bulgusu saptanmıştır (p=0.043).

Sonuç: Acil servise skrotal ağrı, şişlik veya ekimoz şikayetiyle başvuran bir hastanın US'de septasyon görüldüğünde öncelikle hematosel dışlanmalıdır. Septasyon varlığı akut travmada hematoselin hidroselden ayrımında yararlı değildir, ancak kronik hematoselin akut hematosel veya hidroselden ayrımında yararlı olabilir.

Keywords

hematosel, hidrosel, septasyon, ultrason, acil servis

Diagnostic Value of Ultrasonographic Septation in the Differentiation of Scrotal Hematocele and Hydrocele: A Single-Center, Retrospective Study

Abstract

Aim: Since the scrotum and testicles are superficial organs, they can be easily examined by palpation and sometimes transillumination. However, it is not possible to distinguish whether the fluid in the scrotum is hydrocele or hematocele. This study attempts to find an ultrasonographic distinction between hematocele and hydrocele based on a simple finding (septation) that every physician can recognize.

Methods: Patients who were admitted to the emergency department (ED) with complaints of scrotal pain, swelling or redness were divided into two groups: those whose complaints developed due to trauma and those whose complaints developed spontaneously. All included patients underwent scrotal US/Doppler by an emergency medicine specialist with US training.

Results: Of the 61 patients included in the study, 36 (59%) presented with scrotal trauma and 25 (41%) with non-traumatic complaints. While hematocele was detected in 8 (22.2%) and hydrocele was detected in 1 (2.8%) of 36 patients with a history of trauma, neither hematocele nor hydrocele was detected in 27 (75%). On the other hand, septation was detected in 6 of 8 hematocele patients (75%), but no septation was detected in 2 (25%) patients (p = 0.013). However, no signs of septation were found in any of the 28 patients who presented due to scrotal trauma and had no signs of hematocele. When patients with a history of scrotal trauma were categorized according to duration, no signs of septation were detected in 12 patients who had acute or scrotal trauma within 1 week, while signs of septation were detected in 6 of 24 patients (25%) with a history of scrotal trauma 1-4 weeks ago (p = 0.043).

Conclusion: When septation is seen on the US of a patient who presents to the ED with scrotal pain, swelling, or ecchymosis, hematocele must first be ruled out. The presence of septation is not useful in acute trauma for distinguishing hematocele from hydrocele, but it may be useful in distinguishing chronic hematocele from acute hematocele or hydrocele.

Keywords

hematocele, hydrocele, septation, ultrasound, emergency department

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