Spermatic Cord Hematoma in a Collegiate Football Player: a Case Report

Objective: In order to expand the athletic trainer's awareness of acute scrotal injuries, the objective is to present a case of a collegiate football player sustaining a spermatic cord hematoma injury.

Background: Hematomas tend to resolve with conservative management. However, untreated testicular injuries may have serious ramifications, including ischemic atrophy, necrosis, and secondary infection. Exploratory surgery remains the standard for any acute scrotal lesion that cannot be diagnosed by physical examination or by diagnostic testing. Surgical exploration, however, is unnecessary in cases of scrotal hematoma.

Differential Diagnosis: Epididymitis, incarcerated inguinal hemia, testicular torsion, testicular hematocele, and scrotal trauma with hematoma formation.

Treatment: Conservative management including bedrest, ice, slight elevation of the lower extremities, and nonsteroidal anti-inflammatory drugs.

Uniqueness: Noncontact scrotal injuries resulting in moderate swelling, pain, and disability are rare in athletes. This case study presents an athlete who suffered a moderate adductor strain 1 month before the formation of a spermatic cord hematoma. Comparison of the two episodes may be found in the subjective history. The question arises as to whether or not the hematoma formation was a possible complication of the initial adductor muscle injury.

Conclusions: Although scrotal injuries are not life threatening, untreated testicular injures can have immediate and severe consequences. It is essential that athletes with acute scrotal injuries accompanied by swelling and tenderness be evaluated by a physician with training in clinical urology.