Hydrocele
Updates to Article Attributes
Hydroceles are acquired or congenital serous fluid collection between the layers of the tunica vaginalis surrounding a testis or spermatic cord. They are the most common form of testicular enlargement, and present with painless enlargement of the scrotum. On all modalities, hydrocoeles appear as simple fluid, unless complicated by infection or haemorrhage.
Epidemiology
Hydrocele can be diagnosed at any age, with congenital hydrocele being more common in children.
Clinical presentation
Most hydrocele are acquired and present with progressing painless scrotal mass. During physical examination, hydrocele characteristically transilluminates when evaluted with light source. However, hydroceles They can be secondarilybecome painful if infected (see pyocele).
Pathology
Congenital
There are two main subtypes of congenital hydrocele:
- a communicating hydrocele
- a spermatic cord hydrocele 1-2.
In the communicating type fluid collects around a patent processus vaginalis, it having failure to successfully obliterate.
The spermatic cord hydrocele is further subdivided into:
- 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 infant 2
Acquired aetiology
- trauma
- epididymitis
- testicular torsion
- testicular neoplasm
Radiographic features
Ultrasound
Ultrasound is the first modality usually used to evaluate hydroceleshydrocele. It presents as a simple fluid collection surrounding the testis. It is avascular on Doppler evaluation. It may contain septations, calcifications or cholesterol 2.
A funiculocele is a subtype of, however, it doesn't (funiculocele) and encysted hydrocele will not surround the testis, rather being found along the spermatic cord. They
Hydroceles can also appear larger with straining (Valsalva ManouerveManoeuvre) 2. ItThey may contain fibrous adhesions, giving a beaded appearance to the spermatic cord (pachyvaginalitis) 3.
The encysted subtype of spermatic cord hydrocele 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.
Treatment and prognosis
In infants, most hydroceles (around 90%) resolve spontaneously and their are thought to result in incomplete obliteration of the processus vaginalis 4. It is important to assess for any associated herniations in these patients.
Differential diagnosis
Imaging differential considerations include
Rarely, a scrotal tunica cyst and aor scrotal mesothelioma can look like hydrocele. It isThey are usually simple to distinguish themeasily distinguishable from hydroceles.
See also
-<p><strong>Hydroceles</strong> are acquired or congenital serous fluid collection between the layers of the tunica vaginalis surrounding a testis or spermatic cord. They are the most common form of testicular enlargement, and present with painless enlargement of the scrotum. On all modalities, hydrocoeles appear as simple fluid, unless complicated by infection or haemorrhage. </p><h4>Epidemiology</h4><p>Hydrocele can be diagnosed at any age, with congenital hydrocele being more common in children.</p><h4>Clinical presentation</h4><p>Most hydrocele are acquired and present with progressing painless <a href="/articles/scrotal-mass">scrotal mass</a>. During physical examination, hydrocele characteristically transilluminates when evaluted with light source. However, hydroceles can be secondarily infected (see <a href="/articles/pyocele">pyocele</a>).</p><h4>Pathology</h4><h6>Congenital</h6><p>There are two main subtypes of congenital hydrocele:</p><ul>- +<p><strong>Hydroceles</strong> are acquired or congenital serous fluid collection between the layers of the tunica vaginalis surrounding a testis or spermatic cord. They are the most common form of testicular enlargement, and present with painless enlargement of the scrotum. On all modalities, hydrocoeles appear as simple fluid, unless complicated by infection or haemorrhage. </p><h4>Epidemiology</h4><p>Hydrocele can be diagnosed at any age, with congenital hydrocele being more common in children.</p><h4>Clinical presentation</h4><p>Most hydrocele are acquired and present with progressing painless <a href="/articles/scrotal-mass">scrotal mass</a>. During physical examination, hydrocele characteristically transilluminates when evaluted with light source. They can become painful if infected (see <a href="/articles/pyocele">pyocele</a>).</p><h4>Pathology</h4><h6>Congenital</h6><p>There are two main subtypes of congenital hydrocele:</p><ul>
-</ul><h4>Radiographic features</h4><h5>Ultrasound</h5><p>Ultrasound is the first modality usually used to evaluate hydroceles. It presents as a simple fluid collection surrounding the testis. It is avascular on Doppler evaluation. It may contain septations, calcifications or cholesterol <sup>2</sup>.</p><p>A <a href="/articles/funiculocele">funiculocele</a> is a subtype of spermatic cord hydrocele, however, it doesn't surround the testis. They can also appear larger with straining (<a href="/articles/valsalva-manoeuvre">Valsalva Manouerve</a>) <sup>2</sup>. It may contain fibrous adhesions, giving a beaded appearance to the spermatic cord (pachyvaginalitis) <sup>3.</sup></p><p>The encysted subtype of spermatic cord hydrocele shows no communication with the peritoneum and it usually only involves the spermatic cord.</p><h5>MRI</h5><p>On MRI, signal characteristics of the hydroceles are</p><ul>- +</ul><h4>Radiographic features</h4><h5>Ultrasound</h5><p>Ultrasound is the first modality usually used to evaluate hydrocele. It presents as a simple fluid collection. It is avascular on Doppler evaluation. It may contain septations, calcifications or cholesterol <sup>2</sup>.</p><p>Communicating, infantile and vaginal hydroceles will be seen intimately surrounding the adjacent testicle. In contrast, spermatic cord hydroceles such as funicular hydrocele (<a href="/articles/funiculocele">funiculocele</a>) and encysted hydrocele will <em>not</em> surround the testis, rather being found along the spermatic cord.</p><p>Hydroceles can also appear larger with straining (<a href="/articles/valsalva-manoeuvre">Valsalva Manoeuvre</a>) <sup>2</sup>. They may contain fibrous adhesions, giving a beaded appearance to the spermatic cord (pachyvaginalitis) <sup>3.</sup></p><h5>MRI</h5><p>On MRI, signal characteristics of the hydroceles are</p><ul>
-</ul><p>Rarely, a <a href="/articles/scrotal-tunica-cyst">scrotal tunica cyst </a>and a <a href="/articles/scrotal-mesothelioma">scrotal mesothelioma </a>can look like hydrocele. It is usually simple to distinguish them from hydroceles.</p><h4>See also</h4><ul>- +</ul><p>Rarely, a <a href="/articles/scrotal-tunica-cyst">scrotal tunica cyst </a>or <a href="/articles/scrotal-mesothelioma">scrotal mesothelioma </a>can look like hydrocele. They are usually easily distinguishable from hydroceles.</p><h4>See also</h4><ul>
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