Male infant born at 40 weeks gestation with vaginal delivery and cephalic presentation. Birth weight was 3,700 g and height 47 cm. Urological assessment was requested due to the existence of a large bilateral scrotal enlargement.
Physical examination revealed a tension hydrocele in the right hemiscrotal and a mild hydrocele on the left side, with positive transillumination. The left teste was normal in terms of morphology and consistency, but palpation of the right testicle was difficult due to the presence of a tension hydrocele.

Blood tests showed moderate leukocytosis. Urine sediment was normal. Doppler ultrasound was performed by adjusting both the pulse rate and the wall filter to the lowest levels of the ultrasound machine. The findings were bilateral hydrocele, being large on the right side, with the right teste showing preserved arterial Doppler flow, although with an elevated resistance index (RI) (RI=0.82; Normal: 0.48-0.75), absence of venous flow and heterogeneous echogenicity, suggesting areas of destructuring. The left testicle is normal ultrasonographically, presenting a peak systolic velocity of 11 cm/s and diastolic velocity of 5 cm/s, with an IR of 0.55.
Given the suspicion of testicular vascular compromise, surgical exploration was decided eighteen hours after birth. We observed a tension hydrocele with no evidence of cord torsion, and the teste had a purplish colour and a necrotic appearance, so orchiectomy was performed.

The postoperative course was without immediate complications.
The pathological anatomy of the specimen showed testicular haemorrhagic infarction.

After eight months of follow-up the patient is asymptomatic and the left hydrocele has disappeared.