Hydrocele in Emergency Medicine Workup

Updated: Mar 23, 2016
  • Author: Scott E Rudkin, MD, MBA, RDMS, FAAEM, FACEP; Chief Editor: Erik D Schraga, MD  more...
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Workup

Laboratory Studies

A CBC with differential may indicate the existence of an inflammatory process. Urinalysis may detect proteinuria or pyuria.

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Imaging Studies

Inguinal-scrotal imaging ultrasound is indicated to confirm the diagnosis. It may be useful to identify abnormalities in the testis, complex cystic masses, tumors, appendages, spermatocele, or associated hernia. In the context of pain or testicular bleeding after trauma, an imaging test can differentiate between a hydrocele and incarcerated bowel. Hydrocele appears as a cystic mass within the spermatic cord (hydrocele of the cord) or as mass surrounding the testicle. [7, 8]

Doppler ultrasound flow study [9] is recommended to assess perfusion, even if an acute scrotum is clinically unlikely. This must be performed emergently if there is suspicion of testicular torsion or of traumatic hemorrhage into a hydrocele or testes. Sensitivity of Doppler ultrasound is 86-100%; specificity is up to 100%. Limited availability of this test within a clinically useful period reduces its usefulness.

Testicular scintigraphy is a nuclear scan that is particularly useful, especially in children, if testicular torsion is suspected. Decreased or absent flow to one testis or a testicular pole indicates torsion. Sensitivity for torsion can be 90%, but it is decreased with infancy, early torsion, incomplete torsion, and following detorsion. Specificity for torsion can be 90%, but it is decreased in the presence of scrotal fluid collections (eg, hydrocele, hernia, abscess, hematocele).

Abdominal radiographic findings usually are normal in patients with hydrocele. If films demonstrate an obstructive gas pattern, they may help differentiate between incarcerated hernia and hydrocele.

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Procedures

Transillumination is a a light source that is shined through the scrotum and causes the hydrocele to illuminate. The bowel also may transilluminate; thus, positive transillumination findings are not diagnostic of hydrocele. Positive transillumination findings should not stop the clinician from investigating serious causes or comorbid conditions that may be associated with secondary hydrocele. This procedure is not reliable for final diagnosis

Hydrocele aspiration reveals a clear amber fluid. Aspiration is not therapeutic, because the fluid generally reaccumulates quickly. Aspiration of hydroceles is not recommended, because it is associated with a high rate of immediate recurrence and with a risk of introducing an infection. If an associated hernia is present, risk of perforating a loop of bowel also exists.

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