Hydrocele

This page is for adult patients. For pediatric patients, see: Hydrocle (peds).

Background

Scrotal anatomy

Scrotal anatomy

• Accumulation of fluid around the testis
• Most common cause of painless scrotal swelling in children
  • Secondary to persistent processus vaginalis
• Most are right sided
• Most resorb by 18-24 months of age
• Acute symptomatic hydroceles are not benign, require workup

Differential Diagnosis

Testicular Diagnoses

• Scrotal cellulitis
• Epididymitis
• Fournier gangrene
• Hematocele
• Hydrocele
  • Hydrocele (peds)
• Indirect inguinal hernia
• Inguinal lymph node (Lymphadenitis)
• Orchitis
• Scrotal abscess
• Spermatocele
• Tinea cruris
• Testicular rupture
• Testicular torsion
• Testicular trauma
• Testicular tumor
• Torsion of testicular appendage
• Varicocele
• Pyocele
• Testicular malignancy
• Scrotal wall hematoma

Evaluation

Scrotal ultrasound of a 10 cm large hydrocele, with anechoic (dark) fluid surrounding the testicle.

• +Transillumination
• Consider testicular ultrasound

Management

• None indicated

Disposition

• Referral to urologist
• Hydroceles that persisted >1 year or in patients >18 months should undergo ultrasonography to rule out tumor vs inflammatory etiology

See Also

• Testicular diagnoses
• Testicular ultrasound