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

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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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