Unusual extratesticular ultrasound appearance of chronic hematoma: A possible benign ultrasound sign observed in two centres

Abstract Extratesticular lesions in adults are usually benign. Imaging, particularly ultrasonography (US), is essential for the differential diagnosis. When US findings are inconclusive, magnetic resonance imaging (MRI) can provide additional clarity. We present two cases of extratesticular lesions with unique imaging features. In the first case, a 22-year-old patient experienced a steadily enlarging right scrotal mass. In the second case, an 80-year-old patient presented with a right-sided hydrocele. In both cases, ultrasonography revealed extratesticular lesions with hyperechoic septa resembling a “snowy pine branch”. MRI of the younger patient showed low T2-weighted and high T1-weighted signal intensity without contrast enhancement or diffusion restriction. Histopathology confirmed chronic hematoceles, which can be diagnostically challenging due to nonspecific presentations. Although rare in adults, extratesticular malignancies require precise diagnosis. In both cases, the characteristic imaging features, such as the hyperechoic septations resembling a “snowy pine branch” on ultrasonography, were key in the diagnosis of hematoceles.