This 55 y/o male was referred to ultrasound for evaluation of left scrotal tenderness and mass. Selected images from the ultrasound shown above demonstrate fine echogenicity in the hydrocele fluid on the left side. A high protein content and /or cholesterol crystals have been shown to be possible etiologies for the imaging findings. The lack of clinical symptoms will help to exclude an infectious etiology. In scrotal abscess (pyocele) in addition to the usual clinical symptoms, the fluid tends to have a "coarser" echogenicity as shown in the Case of the Week for March 20, 2000.

  1. Collings C, Cronan JJ, Grusmark J. Diffuse echoes within a simple hydrocele: an imaging caveat. J Ultrasound Med 1994 Jun;13(6):439-42 UI:94365904
  2. Gooding GA, Leonhardt WC, Marshall G, Seltzer MA, Presti JC Jr. Cholesterol crystals in hydroceles: sonographic detection and possible significance. AJR Am J Roentgenol 1997 Aug;169(2):527-9 UI:97386679
  3. Witte CL, Witte MH, Drach GW, Butler C. On the proteins of hydrocele fluid. Surgery 1973 Mar;73(3):347-52 UI:73123110
  4. Thambugala RL. Diagnosis of hydrocele: a misleading physical sign. Lancet 1970 Oct 31;2(7679):936 UI:71010565
  5. Undre AR, Talwalkar MG, Tilak GH, Sinclair EA. Treatment of primary hydrocele. A review of 302 cases. J Indian Med Assoc 1966 Sep 1;47(5):224-7 UI:67219912
  6. Namjoshi SP. Calculi in hydroceles: sonographic diagnosis and significance. J Clin Ultrasound 1997 Oct;25(8):437-41 UI:97462932

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