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Hydrocele

Dr Yuranga Weerakkody and Dr Maxime St-Amant et al.

A hydrocele is an acquired or congenital serous fluid collection within layers of the tunicas vaginalis 1. It is the most common form of testicular enlargement 2.

Clinical presentation

Most hydrocele are acquired and present with progressing painless scrotal mass. Characteristically, hydrocele transilluminates when evaluted with light source during physical examination. However, hydroceles can be secondarily infected (see pyocele).

Epidemiology

Hydrocele can be diagnosed at any age, with congenital hydrocele being more common in children.

Pathology

Congenital

There are two subtypes of congenital hydrocele 1-2 :

  • encysted type with no communication with the peritoneum or tunica vaginalis, also called spermatic cord cyst.
  • funicular type which communicates with the peritoneum at the internal ring and doesn't surround the testis. This type is also called funiculocele. They are more frequently encoutered in children and premature infant2.
Acquired aetiology

Radiographic features

Ultrasound

Ultrasound is the first modality usually used to evaluate hydroceles. It presents as a simple fluid collection surrounding the testits. It is avascular on Doppler evaluation. It may contain septations, calcifications and cholesterol 2.

A funiculocele is a sub type of hydrocele, however, it doesn't surround the testis. They can also appear larger with straining (valsalva) 2. It may contain fibrous adhesions, giving a beaded appearance to the spermatic cord (pachyvaginalitis) 3.

The encysted subtype shows no communication with the peritoneum and it usually only involves the spermatic cord.

MRI

On MRI, signal characteristics of the hydroceles are :

  • T1 : low signal
  • T2 : high signal

This represents the simple serous fluid component of the hydrocele.

Differential diagnosis

Rarely, a scrotal tunica cyst and a scrotal mesothelioma can look like hydrocele. It is usually simple to distinguish them from hydroceles.

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