A<unk>  can be produced in four ways: * by excessive production of fluid within the sac, e.g. secondary<unk>  * through defective absorption of fluid * by interference with lymphatic drainage of scrotal structures as in case of elephantiasis * by connection with a hernia of the peritoneal cavity in the congenital variety, which presents as<unk>  of the cord Primary<unk> s The swelling is soft and non-tender, large in size on examination, and the testis cannot usually be felt. The presence of fluid is demonstrated by transillumination. These<unk> s can reach a huge size, containing large amount of fluid, as these are painless and are often ignored. They are otherwise asymptomatic, other than size and weight, causing inconvenience. However the long continued presence of large<unk> s causes atrophy of testis due to compression or by obstructing blood supply. In most cases, the<unk> , when diagnosed early during complete physical examination, are small and the testis can easily be palpated within a lax<unk> . However Ultrasound imaging is necessary to visualize the testis if the<unk>  sac is dense to reveal the primary abnormality. But these can become large in cases when left unattended.<unk> s are usually painless, as are testicular tumors. A common method of diagnosing a<unk>  is by attempting to shine a strong light (transillumination) through the enlarged scrotum. A<unk>  will usually pass light, while a tumor will not (except in the case of a malignancy with reactive<unk> . Secondary<unk> s Secondary<unk> s due to testicular diseases can be the result of cancer, trauma (such as a hernia), or orchitis (inflammation of testis), and can also occur in infants undergoing peritoneal dialysis. A<unk>  is not a cancer but it should be excluded clinically if a presence of a testicular tumor is suspected, however, there are no publications in the world literature that report a<unk>  in association with testicular cancer. Secondary<unk>  is most frequently associated with acute or chronic epididymo-orchitis. It is also seen with torsion of the testis and with some testicular tumors. A secondary<unk>  is usually lax and of moderate size: the underlying testis is palpable. A secondary<unk>  subsides when the primary lesion resolves. * Acute/chronic epididymo-orchitis * Torsion of testis * Testicular tumor * Hematocele * Filarial<unk>  * Post herniorrhaphy *<unk>  of an hernial sac Infantile<unk> s It does not occur only in infants but it occurs in adults also, a<unk>  is usually an expression of a patent processus vaginalis (PPV). The tunica and the processus vaginalis are distended to the inguinal ring but there is no connection with the peritoneal cavity. Congenital<unk> s Communicating<unk> , caused by the failure of the processus vaginalis closure. The processus vaginalis is patent and connects with the general peritoneal cavity. The communication is usually too small to allow herniation of intra-abdominal contents. Digital pressure on the<unk>  does not usually empty it, but the<unk>  fluid may drain into the peritoneal cavity when the child is lying down. Ascites or even ascitic tuberculous peritonitis should be considered if the swellings are bilateral. Encysted<unk>  of the cord There is a smooth oval swelling near the spermatic cord which is liable to be mistaken for an inguinal hernia. The swelling moves downwards and becomes less mobile if the testis is pulled gently downwards. Rarely, a<unk>  develops in a remnant of the processus vaginalis somewhere along the course of the spermatic cord. This<unk>  also transilluminates, and is known as an encysted<unk>  of the cord. In females, a related region in females, a multicystic<unk>  of the canal of Nuck sometimes presents as a swelling in the groin. It probably results from cystic degeneration of the round ligament. Unlike a<unk>  of the cord, a<unk>  of the canal of Nuck is always at least partially within the inguinal canal. The accuracy of the diagnosis must be ascertained. Great care must be taken to differentiate a<unk>  from a scrotal hernia or tumor of the testicle. Ultrasound imaging can be very useful in these cases. A hernia usually can be reduced, transmits a cough impulse, and is not translucent. A<unk>  cannot be reduced into the inguinal canal and gives no impulse on coughing unless a hernia is also present. In young children a<unk>  is often associated with a complete congenital type of hernial sac.
Hydrocele
Urethrocele
Hematocele
Spermatocele
Varicocele
Pneumatocele
Cystocele
Inguinal hernia