Angioembolization of Scrotal Arteriovenous Malformations: A Case Report and Literature Review

Abstract

Arteriovenous malformations (AVMs) of the scrotum are rare lesions, usually diagnosed incidentally during the evaluation of scrotal masses or infertility. It could be presented with acute bleeding or acute pain. We are presenting a case of painless bilateral infiltrated scrotal mass (more advanced in the left side) developed dramatically over a year, no other symptoms existed. The diagnosis was made using duplex ultrasound (DUS), computed tomography arteriography (CTA), and digital subtraction angiography (DSA). Three sessions of angioembolization were performed and followed by surgical resection of the left side of the scrotum.

Scrotal arteriovenous malformation: Case report

“…Scrotal AVM are extremely rare, representing less than 1% of vascular neoformations, making them difficult to diagnose and to find adequate treatment [ 4 , 6 ]. For their diagnosis, the physical exam should be taken into account, as well as evaluation of scrotal inflammation, pain, and history of hemorrhages [7] .…”

“…Among them all, arteriovenous malformations (AVM) are the least common [ [2] , [3] , [4] , [5] ]. Their areas of frequent appearance are the throat, limbs, trunk sites, intracranial and extracranial [6] ; therefore, it is said that AVM in the scrotal region are the most rare [ 1 , [6] , [7] , [8] ].…”

“…AVM are present from birth, produced by alterations in the morphogenesis of the vessels [9] , and grow proportionately to the growth of the child [ 6 , 9 ]. They are characterized by large feeding vessels, hypervascularity and excess of arteriovenous connections at the nidus level [10] ; they may be asymptomatic or present growth in size, bleeding, pain or azoospermia [ 1 , 8 ], and cause infertility, heart failure, and even fatal hemorrhages [ 4 , 11 ].…”

Undiagnosed scrotal swelling in a 36-year-old man: A congenital arteriovenous malformation

“…Due to the almost innumerable anatomic subtypes, their nomenclature has been simplified for ease of use into no-flow, lowflow, or high-flow lesions 3,4 . Few cases exist of combined vascular malformations in the scrotum 5 . Scrotal swelling is a common clinical presentation.…”

“…Frequent diagnoses include inguinal hernias, hydroceles, testicular cancer, and varicoceles. Less common diagnoses include lymphangiomas, arteriovenous malformations, and testicular hemangiomas 5 . While swelling, pain, bleeding, and ulceration are common symptoms of scrotal AVMs, most are detected during infertility evaluations.…”