Diagnostic Ultrasound - Abdomen and Pelvis

Hydrocele
Diagnoses: Scrotum
TERMINOLOGY
• Congenital or acquired serous fluid contained within layers
of scrotal tunica vaginalis
IMAGING
• Scrotal fluid surrounding testis, except for "bare area"
where tunica vaginalis does not cover testis and is attached
to epididymis
• Intrascrotal, external to testis and epididymis
• Not within scrotal wall
• Specific anatomic location: Tunica vaginalis
• Simple or complex avascular fluid
• High-resolution US (9-15 MHz) is modality of choice
PATHOLOGY
• Congenital or communicating hydrocele is due to failure of
processus vaginalis to close
• Secondary occurrence in adults due to epididymitis, trauma,
surgery, or tumor
KEY FACTS
• Simple fluid collection within tunica vaginalis
• Chronic cases show thickened tunica with septation
• Complex fluid may be seen in acute infection or afterwards
• Scrotal hematoma may be slow to resolve and manifest as
complex collection
CLINICAL ISSUES
• Congenital hydroceles usually resolve by 18 months of age
• 25-50% of acquired hydroceles are associated with trauma
• 10% of testicular tumors have associated hydrocele
• Surgical hydrocelectomy: Open drainage of fluid and
oversewing of hydrocele sac edges
• Aspiration and sclerotherapy: Less invasive approach with
slightly higher risk of recurrence
(Left) Transverse color
Doppler ultrasound shows
simple-appearing fluid in a
small hydrocele. Note that the
fluid does not surround the
testicle along the bare area
where the tunica vaginalis
does not cover the testicle and
is attached to the epididymis.
(Right) Massive simple
hydrocele in a 90-year-old man
compresses the right testis
along the scrotal wall. The left
testis st is also visible in this
image.
(Left) Thin septations st are
shown within a minimally
complex hydrocele in a patient
with epidydimo-orchitis.
(Right) Transverse ultrasound
in a newborn boy shows
symmetrical hydrocele in both
hemiscrotums with clear
separation st between right
and left scrotal sac,
characteristic of neonatal
hydrocele.
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