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Hydrocele is a topic covered in the 5-Minute Emergency Consult.

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Emergency Central

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  • Most common cause of painless scrotal swelling.
  • Classified as congenital or acquired (secondary):
    • Congenital result from a patent process vaginalis and communication between tunica vaginalis and peritoneal cavity:
      • Normally occurs spontaneously and most are closed by 2 yr of age
    • Acquired occur secondary to interscrotal infection, neoplasm, inguinal or scrotal surgery, or regional or systemic disease.
  • Communicating hydrocele:
    • Patent processus vaginalis
    • Scrotum fills and empties with peritoneal fluid depending on body position and intraperitoneal pressures.
  • Noncommunicating hydrocele is due to production of serous fluid by a disease process or impaired absorption within the scrotum itself


  • Imbalance between production and resorption of fluid within the space between tunica vaginalis and tunica albuginea.
  • Disease processes causing adult noncommunicating hydrocele include:
    • Epididymitis
    • Hypoalbuminemia
    • TB
    • Trauma
    • Mumps
    • Spermatic vein ligation
    • In developing world, hydrocele is primarily caused by infections such as Wuchereria bancrofti or Loa Loa (filariasis is the cause of most hydroceles worldwide)
    • Rarely malignancy (1st-degree testicular neoplasm or lymphoma)
  • Rare etiology is the abdominoscrotal hydrocele that may cause hydroureter or unilateral limb edema owing to compression:
    • US reveals single sac extending from scrotum into abdominal cavity via the deep inguinal ring.

Pediatric Considerations
  • Congenital in 6% of newborn boys
  • Usually diagnosed in newborn nursery
  • Caused by patent processus vaginalis, a structure that remains patent in 85% of newborns
  • May vary in size owing to position or crying:
    • Patients may present with history of scrotal mass that has resolved.
  • Most close by the age of 2 yr

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Rosen, Peter, et al., editors. "Hydrocele." 5-Minute Emergency Consult, 5th ed., Lippincott Williams & Wilkins, 2016. Emergency Central, emergency.unboundmedicine.com/emergency/view/5-Minute_Emergency_Consult/307183/all/Hydrocele.
Hydrocele. In: Rosen P, Shayne P, Barkin AZ, et al, eds. 5-Minute Emergency Consult. 5th ed. Lippincott Williams & Wilkins; 2016. https://emergency.unboundmedicine.com/emergency/view/5-Minute_Emergency_Consult/307183/all/Hydrocele. Accessed April 26, 2019.
Hydrocele. (2016). In Rosen, P., Shayne, P., Barkin, A. Z., Wolfe, R. E., Hayden, S. R., Barkin, R. M., & Schaider, J. J. (Eds.), 5-Minute Emergency Consult. Available from https://emergency.unboundmedicine.com/emergency/view/5-Minute_Emergency_Consult/307183/all/Hydrocele
Hydrocele [Internet]. In: Rosen P, Shayne P, Barkin AZ, Wolfe RE, Hayden SR, Barkin RM, Schaider JJ, editors. 5-Minute Emergency Consult. Lippincott Williams & Wilkins; 2016. [cited 2019 April 26]. Available from: https://emergency.unboundmedicine.com/emergency/view/5-Minute_Emergency_Consult/307183/all/Hydrocele.
* Article titles in AMA citation format should be in sentence-case
TY - ELEC T1 - Hydrocele ID - 307183 ED - Rosen,Peter, ED - Shayne,Philip, ED - Barkin,Adam Z, ED - Wolfe,Richard E, ED - Hayden,Stephen R, ED - Barkin,Roger M, ED - Schaider,Jeffrey J, BT - 5-Minute Emergency Consult UR - https://emergency.unboundmedicine.com/emergency/view/5-Minute_Emergency_Consult/307183/all/Hydrocele PB - Lippincott Williams & Wilkins ET - 5 DB - Emergency Central DP - Unbound Medicine ER -