# Hemorrhagic epididymal cyst mimicking testicular torsion: A case report

## TL;DR

A case report shows how a hemorrhagic epididymal cyst can mimic testicular torsion, emphasizing the need for accurate diagnosis to avoid unnecessary surgery.

## Contribution

Highlights a rare case where a hemorrhagic epididymal cyst was mistaken for testicular torsion and emphasizes diagnostic strategies to prevent misdiagnosis.

## Key findings

- A 25-year-old male presented with symptoms resembling testicular torsion but was diagnosed with a hemorrhagic epididymal cyst.
- Doppler ultrasound and surgical exploration were key in differentiating torsion from cyst rupture.
- Accurate diagnosis prevented unnecessary orchiectomy in this case.

## Abstract

Testicular torsion is a surgical emergency requiring rapid diagnosis and treatment to prevent testicular loss. However, other conditions, such as hemorrhagic epididymal cyst rupture, can mimic its presentation, posing diagnostic challenges.

A 25-year-old male presented with sudden, severe right scrotal pain. Examination revealed a tender superior epididymal mass. Scrotal ultrasound showed homogeneous fluid collection with normal testicular blood flow. Due to severe pain, surgical exploration ruled out torsion and confirmed a hemorrhagic epididymal cyst, which was excised intact.

Distinguishing testicular torsion from hemorrhagic epididymal cyst rupture is crucial. Doppler ultrasound remains the primary diagnostic tool, with torsion showing absent blood flow, whereas cysts maintain normal or increased vascularization. In unclear cases, surgical exploration is justified to prevent testicular loss.

Although testicular torsion is the most critical cause of acute scrotal pain, alternative diagnoses, such as hemorrhagic epididymal cyst rupture, should be considered. Prompt diagnosis using clinical evaluation and imaging can prevent unnecessary orchiectomy, with surgical exploration remaining the safest option in uncertain cases.

Introduction•Testicular torsion is a surgical emergency requiring rapid diagnosis and treatment.•Prompt differentiation from hemorrhagic epididymal cyst rupture is essential to prevent unnecessary orchiectomy.

Testicular torsion is a surgical emergency requiring rapid diagnosis and treatment.

Prompt differentiation from hemorrhagic epididymal cyst rupture is essential to prevent unnecessary orchiectomy.

Case Presentation•A 25-year-old male presented with acute scrotal pain; ultrasound revealed normal testicular blood flow and an epididymal fluid collection.•Surgical exploration ruled out torsion and confirmed a hemorrhagic epididymal cyst.

A 25-year-old male presented with acute scrotal pain; ultrasound revealed normal testicular blood flow and an epididymal fluid collection.

Surgical exploration ruled out torsion and confirmed a hemorrhagic epididymal cyst.

Discussion•Doppler ultrasound is crucial for differentiating torsion from cyst rupture; surgical exploration remains necessary when uncertainty persists.

Doppler ultrasound is crucial for differentiating torsion from cyst rupture; surgical exploration remains necessary when uncertainty persists.

Conclusion•Prompt imaging and surgical exploration can prevent unnecessary orchiectomy in cases of suspected testicular torsion.

Prompt imaging and surgical exploration can prevent unnecessary orchiectomy in cases of suspected testicular torsion.