British Journal of Urology (1998), 81, 777

CASE REPORT

Spontaneous anticoagulant-induced testicular haemorrhagemimicking a testicular tumourJ . CHONG and J.T. FLYNNDepartment of Urology, Leicester General Hospital, Leicester, UK

Case report

A 35-year old warehouseman presented with a 2-dayhistory of suprapubic pain and a swollen right testicle,but there was no trauma or urinary symptoms. He wastaking warfarin for previous thrombo-embolic disease. Hewas mildly pyrexial and his right testis was swollen,tender and very hard. His international normalized ratio(INR) was 6.5, his white cell count 7.9×109/L and hehad microscopic haematuria. His warfarin was stoppedand antibiotics started. Ultrasonography showed a 2.5 cmrounded, echogenic mass with cystic areas, arising in anddistorting the right testis (Fig. 1). This suggested haemor-rhage but could not exclude an underlying mass lesion.

Fig. 2. Histology of the testis showing haematoma with adjacentWhen the INR decreased, his right testis was explored viadamaged tubules. Haematoxylin and eosin. ×10.an inguinal approach; the firm and solid mass suggested

a tumour and an orchidectomy was performed. HistologyCommentconfirmed an area of haemorrhage occupying almost half

the volume of the testis, with adjacent tubules showing It is well known that 10% of testicular tumours presentnecrotic and degenerative changes (Fig. 2), but there was as an acute painful testis [1]. Scrotal ultrasonographyno evidence of malignancy. has been reported to be up to 99% accurate in diCeren-

tiating benign from malignant disease [2] but in practice,clinical suspicion tends to outweigh the findings onultrasonography in determining the timing and approachof exploration of the acute testis, as in the present case.Spontaneous testicular haemorrhage secondary to antic-oagulation therapy is rare. Among the unusual sites ofsuch spontaneous haematoma are the spinal extraduralspace, the abdominal wall and the spermatic cord [3].

References1 Martin B, Conte J. Ultrasonography of the acute scrotum.

J Clin Ultrasound 1987; 15: 37–442 London NJM, Kinder RB, Rees Y, Watkins E. A prospective

study of the value routine scrotal ultrasonography inurological practice. Br J Urol 1989; 63: 416–9

3 McKenney MG, Fietsam R Jr, Glover JL, Villalba M. Spermaticcord haematoma. Am Surg 1996; 62: 768–9

AuthorsJ. Chong, FRCS, Senior House OBcer.J.T. Flynn, FRCS, Consultant Urologist.Correspondence: Mr J.T. Flynn, Department of Urology, LeicesterFig. 1. Ultrasonogram of the testis showing a 2.5 cm echogenicGeneral Hospital, Gwendolen Road, Leicester LES 4PW, UK.mass with cystic areas.

777© 1998 British Journal of Urology