Category: Abdominal Imaging, Region: Pelvis-Muscular system / Connective tissue / Skin, Plane: Sagittal
A 30 year-old female patient was referred to our surgical department by her gynecologist for a suspected right inguinal hernia. She had a moderately painful swelling in her right groin, palpable up to 3 cm, which she had noticed a week ago. She had no fever, or any gastrointestinal symptoms. Physical examination revealed a localized fluctuant mass in the region of her right inguinal canal that does not increase on the Valsalva maneuver and cannot be reduced by manual pressure. The mass was transilluminant, with no thrill or bruit with and normal overlying skin with no associated inflammation. There were no symptoms of bowel obstruction or other abdominal disease. Pelvic ultrasound showed a 3.5 x 2.6 cm oval shaped completely cystic lesion, with fine echogenic margins, located within the right inguinal region, without internal soft tissue component or vascular structure, without obvious communication with the abdominal cavity [Fig 1, 2 and 3]. A contrast enhanced abdomen and pelvic CT was obtained that demonstrates a similar 3.5 cm tubular-shaped fluid density lesion at the right inguinal canal, without obvious communication with the peritoneal cavity, extending inferiorly into the suprapubic area [Fig 4 through 7]. No soft tissue or vascular components were identified in the mass lesion. The lesion was removed surgically and histopathology revealed the diagnosis of hydrocele of canal of Nuck, with fibrous tissue and flattened mesothelial cells lining the inner surface of a completely cystic lesion, with clear amber fluid, with no internal cells or microorganism.