Calculi in hydroceles: Sonographic diagnosis and significance

Purpose This paper reviews the sonographic appearances of calculi found in hydroceles. Methods The records and sonograms of 350 patients who had scrotal sonography examinations at Salmaniya Hospital, Bahrain, between September 1992 and August 1994 were analyzed retrospectively. Results Seventy‐eight hydroceles were identified. Of those, 32 contained calcareous particles or calculi. Calculi 3 mm or more in diameter were seen incidentally as movable echogenic foci in the hydrocele fluid in 15 patients who had projections and calcifications in the tunica vaginalis, skin thickening, and/or chronic epididymitis. These findings indicated that the likely cause of calculus formation was chronic scrotal inflammation leading to a disturbance in reabsorption of the hydrocele fluid. During sonography, calculi in hydroceles were seen moving in the fluid between the tunica vaginalis layers; this distinguished them from other scrotal calculi or pathologic findings. Conclusions With sonographic identification of calculi in hydroceles, further imaging and surgery may be avoided. © 1997 John Wiley & Sons, Inc. J Clin Ultrasound 25 : 437–441, 1997.