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Special Feature
June 2011

Image of the Month—Quiz Case

Author Affiliations

Author Affiliations: All India Institute of Medical Sciences, New Delhi, India.

 

CARL E.BREDENBERGMD

Arch Surg. 2011;146(6):757. doi:10.1001/archsurg.2011.137-a

A 24-year-old man presented with complaints of a gradually progressive, right lower abdominal swelling and right scrotal enlargement for 2 years. There was no history of pain or sudden increase or decrease in the size of the swelling or urinary disturbances. There was no history of trauma. Physical examination revealed a smooth, fluctuant, right abdominal swelling extending from the level of the umbilicus up to the inguinal ligament (Figure 1). There was a smooth, cystic swelling causing marked enlargement of the right half of the scrotum. There was no local increase in temperature and no tenderness. The left testis was within the scrotum, but the right testis was not palpable. When the patient was asked to cough, the examiner felt a palpable thrill. The abdominal and scrotal swellings, when palpated simultaneously, showed cross-fluctuation. Both the swellings were transilluminant.

Figure 1
A 24-year-old man with right lower abdominal and right scrotal swelling.

A 24-year-old man with right lower abdominal and right scrotal swelling.

Ultrasonography revealed a large, cystic, abdominal mass and a right-sided hydrocele. The right testis could not be visualized. Computed tomography showed a homogenous intra-abdominal mass that continued into the scrotum (Figure 2). The mass caused displacement of the urinary bladder. The right testis was localized in the inguinal canal.

Figure 2
Computed tomographic scan (coronal section) of a 24-year-old man with right lower abdominal and right scrotal swelling. The scan shows the cystic abdominal swelling in continuity with the scrotal swelling.

Computed tomographic scan (coronal section) of a 24-year-old man with right lower abdominal and right scrotal swelling. The scan shows the cystic abdominal swelling in continuity with the scrotal swelling.

What Is the Diagnosis?

A. Abdominoscrotal hydrocele

B. Testicular neoplasm with cystic changes

C. Inguinal hernia with bladder as the content

D. Lymphangioma

Answer

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