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Urogenital Imaging

Open processus vaginalis, spermatic cord

The processus vaginalis is an outpouching of the peritoneal cavity that descends with the testicle into the scrotal sac, ultimately becoming the tunica vaginalis. The tunica vaginalis envelops all but the posterior aspect of the epididymis and testicle. Failure of closure of processus vaginalis allows communication between the peritoneal cavity and tunica vaginalis, resulting in fluid accumulation in the tunica vaginalis. It has been suggested that underdevelopment of lymphatics in the parietal layer of the tunica vaginalis causes impaired absorption of fluid and subsequent development of congenital hydrocoele. Congenital hydrocoeles are diagnosed clinically and usually require no imaging studies. In rare instances a hydrocoele enlarges to extend into the peritoneal cavity and is then termed as abdominoscrotal hydrocoele. Pressure placed on the abdominal component of the hydrocoele may cause enlargement of the hydrocoele of the scrotum.

On sonography, careful scanning of the inguinal region is necessary to identifying communication between the fluid-filled pelvis and scrotal components. CT sections are extended inferiorly to cover the scrotum. MRI offers direct imaging in the sagittal plane. The hydrocoele has low intensity on T1-weighted images and high signal intensity on T2-weighted images, as expected for fluid-filled structure.

HH