Hydrocele of the canal of Nuck: ultrasound and MRI findings

Reports in Medical Imaging, Feb 2011

Hydrocele of the canal of Nuck: ultrasound and MRI findings Edmund Soh1, Kenneth Sheah2, Keh Oon Ong11Department of Radiology, Singapore General Hospital, Singapore; 2Radlink Diagnostic Imaging, Paragon Medical, SingaporeAbstract: Hydrocele (or cyst) of the canal of Nuck is rare and usually presents as a nontender groin mass. Imaging is useful in evaluation, and the diagnosis is suggested if a cystic lesion is found within the inguinal canal. We report the ultrasound and magnetic resonance imaging (MRI) findings of a hydrocele of the canal of Nuck, with MRI demonstrating a multiseptated cystic structure.Keywords: inguinal region, hydroceles, ultrasound diagnosis

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Hydrocele of the canal of Nuck: ultrasound and MRI findings

Reports in Medical Imaging Hydrocele of the canal of Nuck: ultrasound and MRI findings edmund Soh 1 Kenneth Sheah 0 Keh Oon Ong 1 0 Radlink Diagnostic Imaging, Paragon Medical , Singapore 1 Department of Radiology, Singapore General Hospital , Singapore Hydrocele (or cyst) of the canal of Nuck is rare and usually presents as a nontender groin mass. Imaging is useful in evaluation, and the diagnosis is suggested if a cystic lesion is found within the inguinal canal. We report the ultrasound and magnetic resonance imaging (MRI) findings of a hydrocele of the canal of Nuck, with MRI demonstrating a multiseptated cystic structure. - Soh et al 8 1 0 2 l u J 2 1 n o 0 . 5 1 . 5 3 1 . 5 y b / m o c . s s e r .vdoepww l.syoeun from roF d e d a o l n w o d g n i g a m lI a c i d e M n i s tr o p e R Discussion The canal of Nuck is a small protrusion of peritoneum that corresponds to the processus vaginalis in the male. A hydrocele of the canal of Nuck is a rare condition resulting from incomplete obliteration of the canal and entrapment of fluid. Clinically, it usually presents as a nontender mass or swelling in the inguinal region.3 The diagnosis of a hydrocele of the canal of Nuck is suggested by the finding of a cystic lesion in the inguinal canal. The cystic appearances have been described with ultrasound and MRI, the ultrasound appearances ranging from a “comma-shaped lesion with its tail directed toward the inguinal canal”4 to a “cyst-in-cyst” appearance2 to a multiseptated lesion.5 The limited reports of the MRI findings of hydroceles of the canal of Nuck, however, to our knowledge have not described septations, even when seen on ultrasound.6 16 submit your manuscript | www.dovepress.com Dovepress 8 1 0 2 l u J 2 1 n o 0 . 5 1 . 5 3 1 . 5 y b / m o c . s s e r .vdoepww l.syoeun /w la / :s on ttp rs h ep from roF d e d a o l n w o d g n i g a m lI a c i d e M n i s tr o p e R We describe septations which are clearly depicted on MRI and which enhance after intravenous contrast medium. These septations are in keeping with underlying inflammation and/or hemorrhage. The most common differential of hydroceles of the canal of Nuck is the inguinal hernia, and both can coexist in about one-third of patients. The cystic nature of the lesion points towards a hydrocele of the canal of Nuck.7–9 Valsalva maneuvers with ultrasound visualization can also be used to help differentiation from hernias.6 Graded compression of the hydrocele has also been reported to open and distend a patent canal of Nuck.10 Other differentials include incarcerated hernias, abscesses, vascular abnormalities, and cystic-appearing tumors. Ultrasound usually resolves most of these with careful technique and application of color/power Doppler, and of course, correlation with the clinical presentation. The authors would suggest that ultrasound is the first imaging modality of choice in the assessment of groin lesions. Ultrasound is cheap, readily available, and allows dynamic assessment. MRI is suggested as a problemsolving tool. In conclusion, a cystic lesion in the female inguinal canal is suggestive of a hydrocele of the canal of Nuck. Valsalva maneuvers can be used to help confirm the diagnosis. We describe MRI findings of internal septations which were not demonstrated on initial ultrasound. Hydrocele of the canal of Nuck Disclosure The authors report no conflicts of interest in this work. Publish your work in this journal Reports in Medical Imaging is an international, peer-reviewed, open access journal publishing original research, reports, reviews and commentaries on all areas of medical imaging. The manuscript management system is completely online and includes a very quick and fair peer-review system, which is all easy to use. 1. Shadbolt CL , Heinze SB , Dietrich RB . Imaging of groin masses: inguinal anatomy and pathologic conditions revisited . Radiographics . 2001 ; 21 : S261 - S271 . 2. Stickel WH , Manner M. Female hydrocele (cyst of the canal of Nuck): sonographic appearance of a rare and little-known disorder . J Ultrasound Med . 2004 ; 23 : 429 - 432 . 3. Khanna PC , Ponsky T , Zagol B , Lukish JR , Markle BM . Sonographic appearance of canal of Nuck hydrocele . Pediatr Radiol . 2007 ; 37 : 603 - 606 . 4. Park SJ , Lee HK , Hong HS , et al. Hydrocele of the canal of Nuck in a girl: ultrasound and MR appearance . Br J Radiol . 2004 ; 77 ( 915 ): 243 - 244 . 5. Miklos JR , Karram MM , Silver E , Reid R . Ultrasound and hookwire needle placement for localization of a hydrocele of the canal of Nuck . Obstet Gynecol . 1995 ; 85 ( 5 ): 884 - 886 . 6. Safak AA , Erdogmus B , Yazici B , Gokgoz AT . Hydrocele of the canal of Nuck: sonographic and MRI appearances . J Clin Ultrasound . 2007 ; 35 ( 9 ): 531 - 532 . 7. Chandrasekharan LV , Rajagopal AS . The hydrocele of the canal of Nuck: an ultrasound diagnosis . Internet J Radiol . 2006 ; 4:2 . http://www. ispub.com/ostia/index.php?xmlFilePath=journals/ijra/vol4n2/nuck.xml. Accessed January 15 , 2011 . 8. Huang CS , Luo CC , Chao HC , Chu SM , Yu YJ , Yen JB . The presentation of asymptomatic palpable movable mass in female inguinal hernia . Eur J Pediatr . 2003 ; 162 : 493 - 495 . 9. De Meulder F , Wojciechowski M , Hubens G , Ramet J . Female hydrocele of the canal of Nuck: a case report . Eur J Pediatr . 2006 ; 165 : 193 - 194 . 10. Yigit H , Tuncbilek I , Fitoz S , Yigit N , Kosar U , Karabulut B. Cyst of the canal of Nuck with demonstration of the proximal canal: the role of the compression technique in sonographic diagnosis . J Ultrasound Med . 2006 ; 25 : 123 - 125 .


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Edmund Soh, Kenneth Sheah, Keh Oon Ong. Hydrocele of the canal of Nuck: ultrasound and MRI findings, Reports in Medical Imaging, 2011, 15-17, DOI: 10.2147/RMI.S17120