How is it Diagnosed?
Hydrocele, an accumulation of fluid around the testicle within the tunica vaginalis, is
diagnosed primarily through physical examination and confirmed by ultrasound. Patients
usually present with a painless, smooth, and soft scrotal swelling that may fluctuate in
size. Transillumination of the scrotum using a torch light is a key clinical test—hydroceles
allow light to pass through, differentiating them from solid masses like tumors or
hernias.
Palpation helps distinguish hydrocele from inguinal hernia; in hydrocele, the swelling is
confined to the scrotum and non-reducible. In infants, a communicating hydrocele is
suspected if the swelling increases in size when crying or straining.
Scrotal ultrasonography is the gold standard for confirmation and helps rule out other
conditions such as epididymitis, testicular torsion, tumors, or varicocele. In some cases,
a Doppler study is needed to evaluate testicular blood flow. Laboratory tests are usually
not required unless an underlying infection or trauma is suspected. In adults, a history
of trauma, infection, or malignancy may prompt further evaluation. Management
depends on age and severity—many infantile hydroceles resolve spontaneously, while
persistent or symptomatic cases in older children and adults may require surgical
intervention (hydrocelectomy).