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

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.