Painless testicular swelling: What’s your diagnosis?

Case History: A male patient in his fifth decade of life complained of right side testicular swelling that had persisted for 2 weeks. The patient reported no pain.

Figure 1. Longitudinal view of the right testicle showing hydrocele. Epididymal head is also visualized.

Figure 2. Transverse view of the right testicle showing loculated hydrocele.

Diagnosis: Testicular hydrocele

Discussion

Although hydroceles are typically idiopathic in origin, in older males, a hydrocele can occur as a result of injury/trauma, inflammation, or inguinal surgery.¹

Testicular hydrocele is the most common reason for painless scrotal swelling. It affects about 1% of men, mostly above the age of 40 years, and 4.7% of neonates.¹

A testicular hydrocele is not life threatening, but it can be associated with underlying conditions that can be considered more serious.² An infection and hernia can both cause fluid to be trapped and lead to further complications.² Depending on the amount of fluid, a larger hydrocele may result in chronic scrotal pain and may cause injury to scrotal contents such as the testicles.

Treatment

A testicular hydrocele typically goes away on its own within 6 months. Hydroceles can be treated via surgical resection or aspiration if it’s large enough to cause the patient discomfort.¹

References 

1. Ahmad T, Ullah S, Nabi G, Ullah N, Rahman K. A mini review on hydrocele: the most common scrotal problem. Social and Basic Sciences Research Review. 2:12:571-575.

2. Nippoldt T. Hydrocele. Mayo Clinic. 2014. Available at: http://www.mayoclinic.org/diseases-conditions/hydrocele/basics/definition/con-20024139. Accessed on March 1, 2015.

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