"Ultrasound is the modality of choice for the evaluation of tension hydrocele, which presents as a collection of anechoic or echolucent fluid 11. In the majority of cases, Doppler US will reveal a decreased flow to the testis 1."
"increased RI"
"A tension hydrocele is a rare form of hydrocele that may result in impeded arterial inflow and venous outflow to and from the testis 1; testicular ischaemia may result, leading to necrosis of the testicular parenchyma 2."
"A hydrocele is defined as a pathological fluid collection between the two laminae of the tunica vaginalis. Due to the increase in hydrocele volume, intratesticular pressure also increases, and when it becomes greater than the perfusion pressures of the vasculature of the testis, arterial and venous flows are both impaired. The pathogenic mechanism is similar to that of compartment syndrome or tension pneumothorax; vessels are compressed when the pressure arises in a confined compartment 1. In ischaemic testes, reactive hyperaemia may be observed as ischaemic factors like nitric oxide and lactate are accumulated, leading to vasodilation 9."
"absent diastolic flow; lack of diastolic flow has been reported even in an asymptomatic case 8"
"Surgery is considered the gold standard treatment of tension hydrocele, a.k.a. hydrocelectomy 11,12. Under anaesthesia, the scrotum and dartos muscle are incised; the tunica vaginalis is found firm, under extreme pressure due to the hydrocele’s tension, and serous fluid will spurt vigorously following incision 1. However, hydrocelectomy may be accompanied by a number of complications, including 11:"
"A hydrocele is defined as a pathological fluid collection between the two laminae of the tunica vaginalis. Due to the increase in hydrocele volume, intratesticular pressure also increases, and when it becomes greater than the perfusion pressures of the vasculature of the testis, arterial and venous flows are both impaired. The pathogenic mechanism is similar to that of compartment syndrome or tension pneumothorax; vessels are compressed when the pressure arises in a confined compartment 1. In ischaemic testes, reactive hyperaemia may be observed as ischaemic factors like nitric oxide and lactate are accumulated, leading to vasodilation 9."