A 2-week-old boy is brought to the office for his first newborn evaluation. The boy has had persistent swelling of his left scrotum, but there has been no noticeable discomfort. Review of birth records indicates that the patient was born at 37 weeks gestation after an uncomplicated vaginal delivery. He has been breastfeeding well with normal voiding and stooling. Physical examination shows bilateral descended testicles with an enlarged, fluctuant left hemi-scrotum that transilluminates brightly. No inguinal or abdominal masses are present. The most likely cause of this patient's condition is a swelling in which of the following locations?

Question

A 2-week-old boy is brought to the office for his first newborn evaluation.  The boy has had persistent swelling of his left scrotum, but there has been no noticeable discomfort.  Review of birth records indicates that the patient was born at 37 weeks gestation after an uncomplicated vaginal delivery.  He has been breastfeeding well with normal voiding and stooling.  Physical examination shows bilateral descended testicles with an enlarged, fluctuant left hemi-scrotum that transilluminates brightly.  No inguinal or abdominal masses are present.  The most likely cause of this patient's condition is a swelling in which of the following locations?

Quizplus · Accepted Answer

11ec160b_358e_9203_9249_2f825cd9d722_MD0001_00 This patient's clinical presentation is consistent with a congenital, communicating hydrocele, a collection of peritoneal fluid within the tunica vaginalis. During embryogenesis, the testis descends through the inguinal canal, drawing with it a diverticulum of peritoneum into the scrotum. This peritoneal tissue is known as the processus vaginalis. Normally, the communication between the processus vaginalis and the peritoneum is obliterated, and the tunica vaginalis is the remaining tissue overlying the testis and epididymis. A communicating hydrocele results when the processus vaginalis remains patent and allows peritoneal fluid to accumulate in the tunica vaginalis. This type of hydrocele is common in newborns and presents as a painless scrotal swelling that transilluminates. (Choice A) The epididymis is a coiled tube posterior to the testicle that is responsible for the storage, maturation, and transportation of sperm. The caput, or head, of the epididymis is the superior-most aspect of the tube that stores sperm prior to maturation. Inflammation of the epididymis, or epididymitis, is classically associated with Gonorrhea and Chlamydia infection. (Choices B, C, and D) The spermatic cord is a collection of structures that originate in the abdominal cavity and course downward toward the testes. It is covered by 3 layers: internal spermatic fascia, cremasteric fascia, and external spermatic fascia. The internal spermatic fascia immediately overlies the spermatic cord and is derived from the transversalis fascia. The cremasteric fascia arises from the internal oblique abdominal muscle. The external spermatic fascia is derived from the external oblique abdominal muscle. This is the outermost layer of the spermatic cord and lies deep to the dartos muscle and scrotal fascia. (Choice E) The pampiniform plexus is a collection of veins within the spermatic cord. Distension of these veins leads to a varicocele and is clinically described as a palpable "bag of worms." (Choice F) The tunica albuginea is the fibrous tissue that immediately overlies the testicles (ie, beneath the tunica vaginalis) and the corpora cavernosa of the penis. In Peyronie disease, excess collagen formation within the tunica albuginea can cause significant pain and curvature of the penis. Educational objective: A communicating hydrocele results when serous fluid accumulates within the tunica vaginalis in the setting of a patent processus vaginalis. It presents as a painless swelling that transilluminates on examination. __________ References: Evaluation of scrotal masses. (http://www.ncbi.nlm.nih.gov/pubmed/19035065) Hernias and hydroceles. (http://www.ncbi.nlm.nih.gov/pubmed/24085793)

A 2-Week-Old Boy Is Brought to the Office for His