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Epididymal cyst

An epididymal cyst is the most common of epididymal masses.

Epidemiology

They have been reported in 20-40% of asymptomatic individuals 5.

Pathology

They are usually of lymphatic origin 2. Cysts contain clear serous fluid ,lymphocytes ,spermatozoa and debris .

Clinical presentation

Often manifests as a palpable mass. ~ 1/3 rd of patients can be asymptomatic.  It may be more prevalent in mountain bikers 3.

Radiographic features

They can be solitary or multiple with 29% having more than one cyst 5.

Ultrasound
  • cyst contents in uncomplicated cases are anechoic with no internal echoes.
  • posterior acoustic enhancement may be seen.
  • well defined anechoic lesions
  • larger cysts may contain septations 
  • larger cyst may displace the testis which is the differentiating point form hydrocele which envelopes the testis 

Differential diagnosis

Imaging differential considerations include

  • spermatocoele -
    • usually has some internal echotexture, but may be indistinguishable from an epididymal cyst
    • epididymal cysts may arise throughout the epididymis, while spermatoceles almost always arise in the epididymal head 4
  • tunica vaginalis cyst
  • paratesticular abscess - will tend to show surrounding inflammatory changes ; the clinical context is different.
  • small hydrocele to be differentiated from large epididymal cyst with septations

See also

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