Spermatic cord hydrocele

Case contributed by Dr Nikos Karapasias

Presentation

Sweling, erythema and tenderness of the left hemiscrotum. The patient reports a painless swelling of the left hemiscrotum for 6 years. Clinical examination: ovoid, smooth, painless, mobile irreducible swelling, transparent to the incident light.

Patient Data

Age: 65 years
Gender: Male
Ultrasound

Left testis and epididymis are normal in echogenicity, without any fluid in the scrotal sac.

US image of the left scrotum shows an anechoic fluid collection superior and lateral to the left testis, with no internal solid components. No evidence of bowel loop is seen in the fluid collection, which is clearly separated from the scrotal sac. Vascularity is absent in the fluid collection.

Pathology
Large fluid filled membranous sac.

Case Discussion

Spermatic cord hydrocele is a collection of fluid along the spermatic cord that lies superior to the testis and does not communicate with the scrotal sac. It is a rare congenital anomaly resulting from abnormal closure of the processus vaginalis. If the fluid collection persists after closure of the processus vaginalis, it results in a hydrocele of cord (hydrocele of canal of Nuck in females) or a non-communicating hydrocele.

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