Chapter III./3.: Radiologic aspects of hydrocele testis

Kinga Karlinger

III./3.1.: Introduction

III./3.1.1.: General remarks

The detection of the most common fluid accumulation in the scrotum – between the two (parietal and visceral) layers of tunica vaginalis testis  by US is usually easy. Normally, there is some fluid between the two layers which is a filmsy, thin layer. The fluid accumulation (due to anatomic reasons) is usually located anterolaterally. Questioning of the history is important because the fluid accumulation can develop due to different reasons, such as:

III./3.1.2.: Primary or idiopathic hydrocele

There is no known, detectable reason of the development of the fluid accumulation, no signs of e.g. congenital lymphatic drainage are found.

III./3.1.3.: Secondary hydrocele

Often develops based on epididymitis or epididymoorchitis. Testicular tumors are often accompanied by fluid accumulation between the two layers of tunica vaginalis (even in 40%!) which must be an alarming sign to search for a tumor. Fluid can develop as a traumatic consequence as well, either cleir, either bloody. Testicular surgeries can be also accompanied by fluid accumulation. Testicular torsion, testicular infarction can be followed by a hydrocele.

III./3.1.4.: Congenital hydrocele

Even a small amount of fluid (ascites) located in the peritoneal cavity might communicate with the scrotum because the processus vaginalis remained open or patent. Its prevalence is common along with inguinal hernia.

III./3.1.5.: Infantile hydrocele

Develops as a consequence of the finger-like extension of processus funicularis, however, there is no connection with the peritoneal cavity here.

The chapter structure

• III./3.1.: Introduction

  • III./3.1.1.: General remarks

  • III./3.1.2.: Primary or idiopathic hydrocele

  • III./3.1.3.: Secondary hydrocele

  • III./3.1.4.: Congenital hydrocele

  • III./3.1.5.: Infantile hydrocele

• III./3.2.: Ultrasound (US) examination of the testes

  • III./3.2.1.: Technical considerations

  • III./3.2.2.: Echogeneicity features

• III./3.3.: Magnetic resonance (MR) examination of the testes

• III./3.4.: Thermographic examination of the testes

• III./3.5.: Primarily choosable imaging methods in case of hydrocele

  • III./3.5.1.: Ultrasound examination

  • III./3.5.2.: MRI examination

• III./3.6.: Differential diagnosis

  • III./3.6.1.: Spermatocele

  • III./3.6.2.: Varicocele

  • III./3.6.3.: Idiopathic form of scrotal edema

  • III./3.6.4.: Testicular torsion

  • III./3.6.5.: Hydatid torsion

  • III./3.6.6.: Orchitis

  • III./3.6.7.: Epididymitis

  • III./3.6.8.: Scrotal trauma

  • III./3.6.9.: Scrotal hernia

  • III./3.6.10.: Testicular tumors

  • III./3.6.11.: Cryptorchismus

• III./3.7.: Take home messages

References