A hematocele is a collections of blood in a body cavity or potential space. The term most commonly refers to the collection of blood in the tunica vaginalis around the testes, known as a scrotal hematocele. Hematoceles can also occur in the abdominal cavity and other body cavities. Hematoceles are rare, making them harder to diagnose and treat. They are very common especially as slowly growing masses in the scrotum usually in men older than 50 years.
A scrotal mass is a lump or bulge that can be felt in the scrotum. The scrotum is the sac that contains the testicles. It is important to seek emergency medical care if developing sudden pain in the scrotum to avoid damage to the testicle that can be permanent. Hematoceles can be classified into idiopathic and secondary ones. If the hematocele is older, the tunica sac appears filled with spongy material several times larger than the testicular volume. Most of this material is fibrin and cholesterol granulomas . In chronic hematocele the blood clot is totally or partially consisting of connective tissue that contains numerous newly formed blood vessels and hemosiderin-laden macrophages. Connective tissue facing the tunica cavity is lined by fibrin remnants. In its final stages the lesion consists of a thickened, fibrosed, and calcified tunica sac which may also show osseous metaplasia.thumb|[[Scrotal ultrasonography of a hematocele, a couple of weeks after appearance, as a fluid volume with multiple thick septations. The hematocele displays no blood flow on Doppler ultrasonography. A pyocele has a similar appearance, but was excluded by lack of inflammation.]]
Diagnosis
Hematoceles can be a challenge to diagnose since they can mimic cysts or neoplasms. The case study presents the patient with no history of any trauma or previous surgery, and general physical condition being normal. Accuracy of imaging studies is higher for the differential diagnosis of testicular torsion and epididmo-orchitis, which there can still be the possibility of misdiagnosis for hematoceles due to testicular torsion. As of 2017, there has only been 35 cases reported so far in the known world literature, few scattered case reports published in medical journals of different languages.