Hematocele

Overview

A hematocele is a buildup of blood within the layers of tissue that surround the testicle, inside the scrotum. It most often happens after an injury to the groin or scrotum, but can also follow surgery or result from bleeding within the area. Unlike a hydrocele, which is a collection of clear fluid, a hematocele is filled with blood.

A small hematocele may settle on its own as the body reabsorbs the blood, while a large one can cause significant swelling, pain, and pressure on the testicle. Because a serious scrotal injury can also damage the testicle itself, any major groin injury with swelling should be evaluated promptly. The most important goal after any significant scrotal injury is to make sure the testicle and its blood supply are intact, since prompt treatment of a damaged testicle gives the best chance of saving it. For this reason, a hematocele is never just about the blood collection itself but about what the injury may have done to the structures around it.

Symptoms

Symptoms depend on how much blood has collected and how quickly.

• Swelling of the scrotum, which may feel firm or heavy
• Pain or tenderness, often following an injury
• Bruising or discoloration of the scrotal skin
• A feeling of fullness or pressure

A hematocele usually does not let light pass through it on examination, which helps distinguish it from a clear-fluid hydrocele. Severe pain, rapidly growing swelling, or a scrotal injury with bleeding needs urgent medical attention, because the testicle itself may be injured.

Causes

A hematocele forms when blood vessels in or around the testicle bleed and the blood collects in the surrounding sac.

• Injury (trauma): A direct blow, kick, sports injury, or accident to the groin is the most common cause.
• Surgery or procedures: Bleeding after scrotal or groin surgery can collect as a hematocele.
• Bleeding disorders or blood thinners: Conditions or medicines that affect clotting can make bleeding more likely.
• Twisted or damaged tissue: A twisted testicle (torsion) or tumor can sometimes bleed into the scrotum, though these are less common causes.

Risk Factors

• Contact sports or activities with a risk of groin injury
• Recent scrotal or groin surgery
• Use of blood-thinning medication
• A bleeding or clotting disorder

Diagnosis

Diagnosis focuses on confirming a blood collection and, importantly, checking that the testicle is not seriously injured.

• Physical exam: The doctor feels the swelling and checks whether light passes through it; a hematocele usually blocks the light.
• Scrotal ultrasound: The key test, which shows blood collecting around the testicle and assesses the testicle and its blood flow.
• Blood tests: May be done if a bleeding disorder is suspected.

Treatment

Treatment depends on the size of the hematocele and whether the testicle is injured.

• Conservative care: A small hematocele often resolves on its own with rest, scrotal support, ice in the first day or two, and pain relief while the body reabsorbs the blood.
• Surgical drainage: A large or painful hematocele may need an operation to drain the blood and stop ongoing bleeding.
• Repair of the testicle: If the testicle itself is damaged, surgery to repair it is sometimes needed, ideally soon after a serious injury.
• Treating the cause: Managing a bleeding disorder or adjusting blood-thinning medicine, where relevant.

With appropriate care, most people recover well. Small collections often resolve over a few weeks, while larger ones that needed surgery may take longer to settle. Follow-up helps confirm that the swelling is improving and that the testicle is healthy.

Prevention

• Wear protective equipment such as an athletic cup during contact sports
• Take care to avoid groin injuries during high-risk activities
• Follow your care team's advice if you take blood thinners, and report any new swelling promptly
• Seek early evaluation after any significant groin injury so problems are caught early

When to See a Doctor

See a doctor for any new scrotal swelling, especially after an injury. Seek urgent or emergency care if you have:

• Severe scrotal pain
• Rapidly increasing swelling or bruising
• A scrotal injury with bleeding or a wound
• Feeling faint or unwell, which could signal significant blood loss

Prompt evaluation matters because a serious scrotal injury can damage the testicle, and early treatment gives the best chance of preserving it.

Related Topics

Frequently Asked Questions

References

1. MedlinePlus, U.S. National Library of Medicine. Scrotal masses.
2. Urology Care Foundation. Scrotal trauma and masses.
3. National Library of Medicine, StatPearls. Scrotal Trauma.
4. Mayo Clinic. Testicle injury and scrotal swelling.