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An Adolescent Boy With a Painless Enlarged Right Hemiscrotum

A 15-year-old boy, without any significant past illnesses or current complaints, visited his pediatrician for a scheduled annual well-child evaluation. On the reviewof-systems discussion, including the genitourinary system, he denied any problems. On examination of his genitalia, a smooth, enlargement inside his right hemiscrotum was noted. On questioning, the boy stated that the swelling had been present with stable size for approximately 1 year. There was no history of sexual intercourse and no prior injury to his scrotal sac. The patient denied any dragging feeling or pain related to the enlarged scrotum or its contents. Gentle palpation of testes found was believed to be enlarged, smooth, nonindurated, painless right testes with normal contents of the contralateral left hemiscrotal sac. Transillumination was not performed at that time. The tentative clinical diagnosis was benign adolescent macro-orchidism. The boy’s father was instructed to obtain an ultrasound of his son’s scotum (Figure 1), and to seek consultation with a pediatric urologist. The ultrasound image was characteristic of a scrotal (testicular) noncommunicating hydrocele. The consultant pediatric urologist confirmed the diagnosis and suggested watchful waiting instead of immediate scrotal hydrocelectomy, which includes aspiration of contents of the hydrocele sac and excision of the tunica vaginalis enveloping the testes.