Volume 26, Issue 120, February 2022

Protein S deficiency-induced spermatic vein thrombosis, a rare cause of painful scrotal mass: A case report

Muhammad Amir Afiq Zakaria^1♦, Nur Azidawati Ab Halim², Sherreen Elhariri³

¹Bachelor of Medicine and Bachelor of Surgery (MBBS) graduate, International Medical University (IMU), Clinical campus, 70300 Seremban, Negeri Sembilan, Malaysia
²Consultant Radiologist, Department of Clinical Radiology, KPJ Seremban Specialist Hospital, 70200 Seremban, Negeri Sembilan, Malaysia
³Consultant Surgeon, Department of Surgery, IMU, Clinical campus, 70300 Seremban, Negeri Sembilan, Malaysia

^♦Corresponding author
Bachelor of Medicine and Bachelor of Surgery (MBBS) graduate, International Medical University (IMU), Clinical campus, 70300 Seremban, Negeri Sembilan, Malaysia

ABSTRACT

A painful scrotal mass requires prompt surgical intervention. Common diagnoses would include testicular torsion, acute epididymo-orchitis, and strangulated inguinal hernia. However, very rarely, it can be diagnosed as a rare clinical disease, including spermatic vein thrombosis (SVT). We present a case of right SVT possibly precipitated by Protein S deficiency, initially presented with a painful right scrotal lump for 2 days. He was treated with Aspirin tablets for 1 week and remained asymptomatic after 3 weeks of initial presentation. At 12 months follow-up, sequelae of right varicocele had developed. SVT is a rare diagnosis with a left-sided prevalence. The etiology of spontaneous SVT remains unclear. In this case, hypercoagulability due to Protein S deficiency could predispose to the formation of venous thrombotic events. Treatment of spontaneous SVT is suggested based on its anatomical location. Complications linked to this disease include varicocele, testicular infarction, pulmonary embolism, and renal vein thrombosis.

Keywords: Painful scrotal mass; Spermatic vein thrombosis; Scrotal Doppler ultrasound; Varicocele; Protein S deficiency

Medical Science, 2022, 26, ms67e2038

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DOI: https://doi.org/10.54905/disssi/v26i120/ms67e2038

Published: 16 February 2022