Presentation
Chronic right hemiscrotal pain, negative trauma. Request for scrotal ultrasound.
Patient Data
There is a small, septated and complex superior right hydrocele. There is an incidental right testicular appendix. There is no evidence to suggest a testicular appendiceal torsion. There are dual left epididymal head cysts, both subcentimeter, one appears simple and the second appears complex. The testes and epididymides are otherwise normal. There are no varicoceles bilaterally.
Sonographer: Ms Roekshana Nana
Annotated images demonstrate the ovoid, sessile testicular appendix at the typical superior location, in the background of a hydrocele.
Case Discussion
There is an incidental left testicular appendix. This is typically well identified in the presence of a hydrocele as in this example. The testicular appendix is often found at the superior pole of the testis within a groove between the testis and epididymal head as is demonstrated here. It represents a congenital remnant of the Mullerian duct. The testicular appendix appears oval and sessile. When it is pedunculated, the testicular appendix is at risk of torsion and this may account for acute pain and presentation in the absence of other positive scrotal ultrasound findings.
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