Sonographic "millipede sign": Spontaneous spermatic varicocele thrombosis presenting as acute scrotal pain.

Congress:

ECR 2020

Poster Number:

C-13832

Type:

Educational Exhibit

Keywords:

Not applicable, Varices, Acute, Diagnostic procedure, Ultrasound-Spectral Doppler, Ultrasound-Colour Doppler, Ultrasound, Veins / Vena cava, Vascular, Genital / Reproductive system male, Genitourinary

Authors:

C. Shilagani¹, P.-Y. J. sonke², A. Jednyak³; ¹Valhalla, NY/US, ²Tarrytown , ny/US, ³Valhalla/US

DOI:

10.26044/ecr2020/C-13832

DOI-Link:

https://dx.doi.org/10.26044/ecr2020/C-13832

Fig. 1: There is a curvilinear hypoechoic tubular structure with internal low-level...

Fig. 2: Dilated right varicocele does not demonstrate flow on color doppler image...

Fig. 3: There is a 3.4 mm curvilinear hypoechoic tubular structure in the left...

Fig. 4: Dilated left spermatic cord vein without internal flow on color doppler image...

Learning objectives

Discuss and describe the differential diagnosis of acute scrotal pain. Describe the sonographic caterpillar sign of the scrotum. Discuss the underlying pathology and management of spermatic vein or varicocele thrombosis.

Background

Scrotal emergencies account for an extremely small percentage of emergency room visits. However, due to the nature of the emergency an early diagnosis is essential to exclude fertility-threatening diagnoses. In this presentation, we will review few of the common causes of acute scrotal pain in addition to the spermatic vein thrombosis to compare and contrast the patient presentation, imaging appearance and management. Testicular torsion: A misnomer as the true cause of acute scrotal pain is torsion of the spermatic cord. This can occur at any...

Findings and procedure details

Case #1: 48-year-old male with history of human immunodeficiency virus infection currently undergoing therapy presented to our outpatient facility with chronic hematospermia. Scrotal ultrasound demonstrated normal bilateral testes and epididymi. Evaluation of the right inguinal canal demonstrated right varicocele with curvilinear tubular hypoechoic structure with internal low-level echoes (Fig. 1) and no internal flow on color doppler imaging (Fig. 2). A diagnosis of right spermatic vein thrombosis was made and patient was recommended to follow-up with his primary care physician. No intraabdominal pathology was seen...

Conclusion

Spermatic vein thrombosis is a rare cause of acute scrotal pain. Sonographic “millipede sign” can be utilized to diagnose a spermatic varicocele thrombosis and allow prompt management or further work-up to diagnose the underlying cause.

Personal information and conflict of interest

C. Shilagani; Valhalla, NEW YORK/US - nothing to disclose A. Jednyak; Valhalla/US - nothing to disclose P.-Y. J. Sonke; Tarrytown, NY/US - nothing to disclose

References

Avery LL, Scheinfeld MH. Imaging of penile and scrotal emergencies. Radiographics. 2013; 13(3):721-740. Mallat F, Hmida W, Ahmed K et al. Spontaneous spermatic vein thrombosis as a circumstance of discovery of the nutcracker syndrome: An exceptional entity. International Journal of Case Reports and Images. 2014;5(7):519-523. Murthy P, Gill B, Khurana S et al. Spermatic Vein thrombosis. Urology. 2018;119:32-34. Raghavendran M, Venugopal A, Kumar GK. Thrombosed varicocele: A rare cause for acute scrotal pain: A case report. BMC Urology. 2018;18(1) Robayna AA, Talavera JR, Martinez BB...