| Discussion: Spermatic cord hydrocele (SCH) is a loculated fluid collection along the spermatic cord, separated from and located above the testicle and the epididymis. This entity is a rare congenital anomaly resulting from an abnormal closure of the processus vaginalis. Affected children usually present with a firm groin swelling, and ultrasound (US) evaluation of the inguinal region is performed to exclude an incarcerated inguinal hernia, inguinal lymphadenopathy or an extratesticular tumour.
Two types of SCH are recognized The first type is encysted hydrocele (EH) of the cord, where the fluid collection does not communicate with the peritoneum or the tunica vaginalis. The second type is the funicular hydrocele (FH), where there is a fluid collection along the cord, communicating with the peritoneum at the internal ring.First, the EH of the cord, which may be localized anywhere along the spermatic cord, may be of any size or shape but does not change in its size or shape with increased intraperitoneal pressure and may resolve spontaneously. Second, the FH, which may grow with increased intraperitoneal pressure, such as with crying or straining, or diminish in size during relaxation. In both types of SCH, no peristalsis or bowel loop should be identified in it and no vascularity should be present on Doppler US examination.
More often this entity is examined by ultrasound rather than CT. US shows an oval anechoic mass in the groin along the spermatic cord, above and separated from the testis and the epididymis. The fluid masses were well demarcated and avascular when examined by colour Doppler US.
During fetal life the parietal peritoneal membrane extends through the internal inguinal ring to form the PV. Between the 28th and 40th weekof gestation, when the testes descend from the abdomen to the scrotum, the PV becomes attached to the testis and remains as the tunica vaginalis.Near to birth, the PV closes and becomes atretic. Normally, no communication remains between the peritoneal cavity and the scrotum. However, in 20% of the population the PV remains patent, but usually without symptoms throughout life. Conditions that may cause delayed closure or non-closure of the PV and thus predispose to a SCH include prematurity, cystic fibrosis, Ehlers–Danlos syndrome, hip dysplasia, peritoneal dialysis or ventriculoperitoneal shunt. Failure of the PV to close may result in a spectrum of pathologies. Complete patency of the PV may cause a communicating hydrocele or an indirect inguinal hernia. On the other hand, patency localized at level of the testis may produce a testicular hydrocele, which is a fluid collection located only at the level of the scrotum between the two layers of the tunica vaginalis.
Discussion taken from
http://bjr.birjournals.org/cgi/content/full/74/885/818 |
2 YEAR OLD WITH PALPABLE MASS
