title: Scrotal Hematoma Precipitated by Centrifuge Training in a Fighter Pilot with an Asymptomatic Varicocele.
abstract: BACKGROUND
  Varicocele is quite common in the general population, affecting up to 15% of men. It is not considered disqualifying for the pilot's training program of the Israeli Air Force as long as there are no related symptoms or associated pathologies. During combat flight, increased venous pressure due to acceleration forces and anti-G straining maneuvers, used to counteract high gravitational G forces, can theoretically aggravate the venous blood pooling in varicocele, leading to rupture.
  
  
  METHODS
  We describe a case of a young fighter-jet pilot presenting with a painful inguinal hematoma extending to the scrotum a day after participating in centrifuge training. Sonographic examination demonstrated dilated spermatic veins and intratesticular varicocele along with subcutaneous thickening of the scrotal wall consistent with hematoma.
  
  
  CONCLUSIONS
  The effects of high G loads on blood flow in spermatic veins, and especially in varicocele, still need to be determined. Varicocele rupture has been described in relation to increased intra-abdominal pressure and could theoretically occur during anti-G straining maneuvers. Such an acute adverse event during combat flight can be detrimental to flight safety and the pilot's well-being.
authors.affiliation: Israeli Air Force Aero Medical Center, IDF Medical Corps, Tel Hashomer, Israel.
authors.forename: Liyona
authors.initials: L
authors.lastname: Kampel
authors.forename: Eyal
authors.initials: E
authors.lastname: Klang
authors.forename: Harry
authors.initials: H
authors.lastname: Winkler
authors.forename: Barak
authors.initials: B
authors.lastname: Gordon
authors.forename: Yael
authors.initials: Y
authors.lastname: Frenkel-Nir
authors.forename: Yifat Erlich
authors.initials: YE
authors.lastname: Shoam
mesh_terms: D000337:Aerospace Medicine; D058070:Asymptomatic Diseases; D002498:Centrifugation / Q000009:adverse effects*; D006406:Hematoma / Q000000981:diagnostic imaging / Q000209:etiology*; D006801:Humans; D007557:Israel; D008297:Male; D008889:Military Personnel; D012611:Scrotum / Q000000981:diagnostic imaging; D000066908:Simulation Training; D014463:Ultrasonography; D014646:Varicocele / Q000150:complications* / Q000000981:diagnostic imaging; D055815:Young Adult