Scrotal swelling in a patient with paroxysmal supraventricular tachycardia

We present a case of a patient with paroxysmal\udsupraventricular tachycardia and a history of\udchronic ischemic disease evolved into dilated\udcardiomyopathy. During hospitalization, the\udoccurrence of arrhythmic crisis, our patient\udfelt sporadic palpitations associated with\uddyspnea, distended jugular veins and scrotal\udswelling, quite unexpected clinical sign that\udcaught our attention. Echocardiography showed\uddilated left ventricle, severely reduced systolic\udfunction, dilated right-sided, dilated inferior\udvena cava with reduced respiratory excursions.\udEchography of both testicles showed bilateral\udexpansion of pampiniform plexus with reflux to\udthe functional maneuvers, such as varicocele of\udgrade III–IV. Afterwards coronary angiography,\udthe placement of a metallic stent in left\udanterior descending artery improved coronary\udcirculation with the net reduction of dyspnea. In\udlater episodes of supraventricular tachycardia\udthe only symptom that the patient felt was mild\udpalpitation associated with scrotal swelling and\uddistended jugular veins. The increased heart\udrate led to an exacerbation of the underlying\udRiccardo Bentivegna1, Domenico Nobile1, Giuseppina\udNovo2, Salvatore Novo3\udAffiliations: 1MD, Doctor, cardiology, University Hospital\ud“Paolo Giaccone”, Palermo, Italy; 2MD, Professor of Cardiovascular\udDiseases, cardiology University Hospital “Paolo\udGiaccone”, Palermo, Italy; 3MD, Professor of Cardiovascular\udDiseases – FESC, cardiology, University Hospital “Paolo Giaccone”,\udPalermo, Italy.\udCorresponding Author: Dr. Riccardo Bentivegna, Via Alcide\udDe Gasperi n°197, Sciacca (AG), 92019, Italy; E-mail: mich.\udbentivegna@alice.it\udReceived: 16 October 2016\udAccepted: 24 November 2016\udPublished: 01 April 2017\udpulmonary hypertension resulting in venous\udstasis upstream the pulmonary capillaries.\udRestoring sinus rhythm, the heart performs its\udnormal pump function and the pressure within\udthe pulmonary capillaries was decreased, so on\udphysical examination turgor of the jugular veins\udand scrotal size were strongly reduced