Scrotal swelling in a patient with paroxysmal supraventricular tachycardia

We present a case of a patient with paroxysmalsupraventricular tachycardia and a history ofchronic ischemic disease evolved into dilatedcardiomyopathy. During hospitalization, theoccurrence of arrhythmic crisis, our patientfelt sporadic palpitations associated withdyspnea, distended jugular veins and scrotalswelling, quite unexpected clinical sign thatcaught our attention. Echocardiography showeddilated left ventricle, severely reduced systolicfunction, dilated right-sided, dilated inferiorvena cava with reduced respiratory excursions.Echography of both testicles showed bilateralexpansion of pampiniform plexus with reflux tothe functional maneuvers, such as varicocele ofgrade III–IV. Afterwards coronary angiography,the placement of a metallic stent in leftanterior descending artery improved coronarycirculation with the net reduction of dyspnea. Inlater episodes of supraventricular tachycardiathe only symptom that the patient felt was mildpalpitation associated with scrotal swelling anddistended jugular veins. The increased heartrate led to an exacerbation of the underlyingRiccardo Bentivegna1, Domenico Nobile1, GiuseppinaNovo2, Salvatore Novo3Affiliations: 1MD, Doctor, cardiology, University Hospital“Paolo Giaccone”, Palermo, Italy; 2MD, Professor of CardiovascularDiseases, cardiology University Hospital “PaoloGiaccone”, Palermo, Italy; 3MD, Professor of CardiovascularDiseases – FESC, cardiology, University Hospital “Paolo Giaccone”,Palermo, Italy.Corresponding Author: Dr. Riccardo Bentivegna, Via AlcideDe Gasperi n°197, Sciacca (AG), 92019, Italy; E-mail: mich.bentivegna@alice.itReceived: 16 October 2016Accepted: 24 November 2016Published: 01 April 2017pulmonary hypertension resulting in venousstasis upstream the pulmonary capillaries.Restoring sinus rhythm, the heart performs itsnormal pump function and the pressure withinthe pulmonary capillaries was decreased, so onphysical examination turgor of the jugular veinsand scrotal size were strongly reduced.