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Case of the Month

December 2011

Patient Data: 3 weeks old boy

Clinical Info: Scrotal swelling. An ultrasound was requested to confirm a hydrocele

Longitudinal image of a 3 weeks old boy with a scrotal swelling. There is a small hydrocele. The right testis shows cystic changes at the rete testis

Transverse image of the same testis with cystic changes. The epididymis is normal

The testis has a normal vascularity

Longitudinal image of the normal left testis and epididymis. There is also a small hydrocele. Because of the asymmetric cystic changes in the testes a cystic dysplasia was the first most likely diagnosis. Because this is often associated with other urinary tract abnormalities the patient was exanined in a pediatric urologic center No other congenital urinary tract abnormalities were found

Longitudinal image of the same testis several months later. The cystic structures are now nearly completely diminished

Transverse image of the testis with barely visible cysts.In this case the cyst are reversible, so are not a true cystic dysplasia of the rete testis but only cystic changes of the rete testis

Longitudinal image of a normal right testis in a 2 year old boy. The left testis was not palpable

Transverse image of the same normal right testis. The left testis could not be found with ultrasound. Therefore we checked the kidneys

There was also no left kidney

The right kidney was larger than normal. An undescended testis must be differentiated from an agenesis of the testis. An agenesis of a testis is always associated with an agenesis of the kidney on the same side. In this case confirming the agenesis of the teft testis

The first patient had cystic changes of the rete testis. Cystic dysplasia of the testis is often associated with abnormalities of the kidney on the same side In this case the kidneys were normal and the cysts reversible. The second boy had an agenesis of the left testis and the left kidney.

For more scrotal abnormalities in children see

Copyright © Dr. T.S.A. Geertsma, Ziekenhuis Gelderse Vallei, Ede, The Netherlands. All rights reserved.

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