Scrotal Mass
Paula J. Woodward, MD
DIFFERENTIAL DIAGNOSIS
Common
Hydrocele
Less Common
Testicular Torsion
Inguinal Hernia
ESSENTIAL INFORMATION
Helpful Clues for Common Diagnoses
Hydrocele
Simple hydrocele
Anechoic fluid
Fluid forms “half moon” crescent around testis
Large hydrocele may completely surround testis
May be isolated or part of generalized hydrops
2/3 unilateral, 1/3 bilateral
Testes normal
Usually transient finding with most resolved by birth
Complex hydrocele
Fluid with linear/focal echoes
Suggests a secondary process: Hemorrhage, testicular infarction/torsion
Helpful Clues for Less Common Diagnoses
Testicular Torsion
Testis may be either large (acute) or small (chronic)
Variable echogenicity
Diffusely hypoechoic from edema
Heterogeneous from infarction
Scrotal edema
Complex hydrocele from hemorrhage or inflammatory reaction
“Double ring hemorrhage” variant: Hemorrhage trapped in two spaces
Between visceral and parietal tunica vaginalis
Between tunica vaginalis and scrotum
Doppler rarely helpful, unless obvious flow in normal testis
Inguinal Hernia
Bowel herniates through inguinal canal
Cystic/echogenic mass in scrotum
Look for peristalsis
Hydrocele common
Look for a normal testis adjacent to mass
Other Essential Information
Normal testicular descent at 25-32 wks
Processus vaginalis forms from extension of peritoneal cavity and aids in descent of testis
Normally obliterates and becomes tunica vaginalis
Hydrocele forms if persistent patent processus vaginalis or fluid not resorbed
Patent processus vaginalis also risk factor for inguinal hernia
Always consider torsion in setting of complex hydrocele
Testis is rarely saved when torsion diagnosed in utero
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