Figure 1
In utero diagnosis of hydrocele
Congenital hydrocele
SectionGenital (female) imaging
Case TypeClinical Cases
AuthorsDR. V.C. VANDANAA , MBBS., DMRT. DEPARTMENT OF RADIOLOGY, SRIMANAKULA VINAYAGAR MEDICAL COLLEGE AND HOSPITAL, PONDICHERRY, INDIA.
Connected authors
28 years, female
Clinical History
28-year-old female, gravida 2 came for her third trimester scanning. She had no specific complaints. The gestational age of the foetus according to the last menstrual period was 38 weeks.
Imaging Findings
Sonography revealed a single live intrauterine gestation corresponding to 38 weeks. Foetal cardiac activity was normal. The liquor was adequate. The placenta was right lateral and posterior and not
ending low. The extremities and spine appeared normal. It was a male foetus. The scrotal sac appeared enlarged with an anechoic fluid collection surrounding the testes. It was significant in one
hemiscrotum and minimal in the other sac. The scrotal sac thickness appears normal. Both the testes appeared normal in size and shape..
ending low. The extremities and spine appeared normal. It was a male foetus. The scrotal sac appeared enlarged with an anechoic fluid collection surrounding the testes. It was significant in one
hemiscrotum and minimal in the other sac. The scrotal sac thickness appears normal. Both the testes appeared normal in size and shape..
Discussion
The reproductive organs in both sexes develop from primordia that are identical at first.
Gonads develop at week 5 from thickened mesodermal epithelium on the medial side of the mesonephros, at the gonadal ridge. Primary epithelial sex cords grow into the underlying mesenchyme. During this indifferent stage, an embryo has the potential to develop into either a male or a female. The indifferent gonads consist of a cortex and medulla. In the male XY the cortex regresses and the medulla develops. The reverse occurs in the female XX. Gonadal sex is determined by the Y chromosome, which exerts a positive testis-determining action on the indifferent gonad. The H-Y antigen determined by the Y chromosome directs testicular differentiation. In the presence of a Y chromosome, testes develop and produce an inducer substance stimulating development of the mesonephric ducts into the male genital ducts . Androgens from the fetal testes stimulate development of the indifferent external genitalia into the penis and scrotum. Müllerian inhibiting substance produced by the testes, inhibits development of the paramesonephric ducts. Between the 3rd month of pregnancy and its end the testes become transferred from the lumbar area into the future scrotum. This transfer is due to a combination of growth processes and hormonal influences. The gubernaculum testis also plays a decisive role in this phenomenon. The gubernaculum testis arises in the course of the 7th week from the lower gubernaculum, after the mesonephros has atrophied. Cranially it has its origin at the testis and inserts in the region of the genital swelling. At the same time, at the inguinal canal along the lower gubernaculum, an evagination of the peritoneum arises, the vaginal process, on which the testes will slide through the inguinal canal. Between the 7th and the 12th week the gubernaculum shortens and pulls the testes, the deferent duct and its vessels downwards. Between the 3rd and 7th month the testes stay in the area of the inguinal canal so they can enter into it. They reach the scrotum at roughly the time of birth under the influence of the androgen hormone. While in the first year of life the upper part of the vaginal process becomes obliterated, there remains only the peritoneo-vaginal ligament. The lower portion persists as the tunica vaginalis testis, which consists of a parietal and a visceral layer. The processus vaginalis and tunica vaginalis are obliterated and contain no fluid. Fluid can then flow to the scrotum to surround the testicle. This sac usually closes and the fluid is absorbed. In noncommunicating hydrocele the processus vaginalis is obliterated so no fluid can move between the abdomen and the scrotum, but the tunica vaginalis contains fluid. This type of hydrocele is often found in newborns and the fluid will usually be absorbed with time. In communicating hydrocele the processus vaginalis is still open, allowing fluid to move between the abdomen and the tunica vaginalis in the scrotum. Surgery is recommended if the hydrocele is still present after 12 - 18 months of age.
Gonads develop at week 5 from thickened mesodermal epithelium on the medial side of the mesonephros, at the gonadal ridge. Primary epithelial sex cords grow into the underlying mesenchyme. During this indifferent stage, an embryo has the potential to develop into either a male or a female. The indifferent gonads consist of a cortex and medulla. In the male XY the cortex regresses and the medulla develops. The reverse occurs in the female XX. Gonadal sex is determined by the Y chromosome, which exerts a positive testis-determining action on the indifferent gonad. The H-Y antigen determined by the Y chromosome directs testicular differentiation. In the presence of a Y chromosome, testes develop and produce an inducer substance stimulating development of the mesonephric ducts into the male genital ducts . Androgens from the fetal testes stimulate development of the indifferent external genitalia into the penis and scrotum. Müllerian inhibiting substance produced by the testes, inhibits development of the paramesonephric ducts. Between the 3rd month of pregnancy and its end the testes become transferred from the lumbar area into the future scrotum. This transfer is due to a combination of growth processes and hormonal influences. The gubernaculum testis also plays a decisive role in this phenomenon. The gubernaculum testis arises in the course of the 7th week from the lower gubernaculum, after the mesonephros has atrophied. Cranially it has its origin at the testis and inserts in the region of the genital swelling. At the same time, at the inguinal canal along the lower gubernaculum, an evagination of the peritoneum arises, the vaginal process, on which the testes will slide through the inguinal canal. Between the 7th and the 12th week the gubernaculum shortens and pulls the testes, the deferent duct and its vessels downwards. Between the 3rd and 7th month the testes stay in the area of the inguinal canal so they can enter into it. They reach the scrotum at roughly the time of birth under the influence of the androgen hormone. While in the first year of life the upper part of the vaginal process becomes obliterated, there remains only the peritoneo-vaginal ligament. The lower portion persists as the tunica vaginalis testis, which consists of a parietal and a visceral layer. The processus vaginalis and tunica vaginalis are obliterated and contain no fluid. Fluid can then flow to the scrotum to surround the testicle. This sac usually closes and the fluid is absorbed. In noncommunicating hydrocele the processus vaginalis is obliterated so no fluid can move between the abdomen and the scrotum, but the tunica vaginalis contains fluid. This type of hydrocele is often found in newborns and the fluid will usually be absorbed with time. In communicating hydrocele the processus vaginalis is still open, allowing fluid to move between the abdomen and the tunica vaginalis in the scrotum. Surgery is recommended if the hydrocele is still present after 12 - 18 months of age.
Differential Diagnosis List
Congenital hydrocele
Final Diagnosis
Congenital hydrocele
Case information
| URL: | https://www.eurorad.org/case/5852 |
| DOI: | 10.1594/EURORAD/CASE.5852 |
| ISSN: | 1563-4086 |
