Scrotal swelling in a patient with paroxysmal supraventricular tachycardia

Abstract

We present a case of a patient with paroxysmal supraventricular tachycardia and a history of chronic ischemic disease evolved into dilated cardiomyopathy. During hospitalization, the occurrence of arrhythmic crisis, our patient felt sporadic palpitations associated with dyspnea, distended jugular veins and scrotal swelling, quite unexpected clinical sign that caught our attention. Echocardiography showed dilated left ventricle, severely reduced systolic function, dilated right-sided, dilated inferior vena cava with reduced respiratory excursions. Echography of both testicles showed bilateral expansion of pampiniform plexus with reflux to the functional maneuvers, such as varicocele of grade III–IV. Afterwards coronary angiography, the placement of a metallic stent in left anterior descending artery improved coronary circulation with the net reduction of dyspnea. In later episodes of supraventricular tachycardia the only symptom that the patient felt was mild palpitation associated with scrotal swelling and distended jugular veins. The increased heart rate led to an exacerbation of the underlying Riccardo Bentivegna1, Domenico Nobile1, Giuseppina Novo2, Salvatore Novo3 Affiliations: 1MD, Doctor, cardiology, University Hospital “Paolo Giaccone”, Palermo, Italy; 2MD, Professor of Cardiovascular Diseases, cardiology University Hospital “Paolo Giaccone”, Palermo, Italy; 3MD, Professor of Cardiovascular Diseases – FESC, cardiology, University Hospital “Paolo Giaccone”, Palermo, Italy. Corresponding Author: Dr. Riccardo Bentivegna, Via Alcide De Gasperi n°197, Sciacca (AG), 92019, Italy; E-mail: mich. bentivegna@alice.it Received: 16 October 2016 Accepted: 24 November 2016 Published: 01 April 2017 pulmonary hypertension resulting in venous stasis upstream the pulmonary capillaries. Restoring sinus rhythm, the heart performs its normal pump function and the pressure within the pulmonary capillaries was decreased, so on physical examination turgor of the jugular veins and scrotal size were strongly reduced.