British Journal of Radiology (2004) 77, 243-244
© 2004 British Institute of Radiology
doi: 10.1259/bjr/51474597
Hydrocele of the canal of Nuck in a girl: ultrasound and MR appearance
S J Park, MD
1
H K Lee, MD
1
H S Hong, MD
1
H C Kim, MD
1
D H Kim, MD
1
J S Park, MD
1 and
E J Shin, MD
2
Departments of 1 Radiology and 2 Surgery, Soonchunhyang University, 1174 Jung-dong, Womni-gu, Gyeonggi-do, 420-021, Republic of Korea
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Abstract
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Hydrocele of the canal of Nuck is a rare condition in females. A small evagination of parietal peritoneum forms the canal of Nuck. Failure of complete obliteration of the canal results in either an indirect inguinal hernia or a hydrocele of the canal of Nuck. We present a case in a 7-year-old girl. On ultrasound, there was a comma-shaped cyst with the tail directed cranially toward the inguinal canal. The cyst had no internal echoes and demonstrated increased through transmission. Coronal and axial MR showed a thin walled cystic mass.
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Introduction
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In the female, the round ligament is attached to the uterus near the origin of the fallopian tube and a small evagination of parietal peritoneum accompanies the round ligament through the inguinal ring into the inguinal canal [1]. This small evagination of parietal peritoneum is the canal of Nuck in the female, homologous to the processus vaginalis in the male. The canal of Nuck normally undergoes complete obliteration during the first year of life. Failure of complete obliteration results in either an indirect inguinal hernia or a hydrocele of the canal of Nuck [1, 2]. To our knowledge, reports of radiological findings of hydrocele of the canal of Nuck have been rare, and MR findings have not been previously described in the English literature.
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Case report
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A 7-year-old girl presented with a palpable mass in her right inguinal region. Physical examination revealed that the mass was tense, but not painful. Ultrasound of the right inguinal area was performed with a 7–10 MHz linear array transducer. The mass was a comma-shaped cyst with a tail directed cranially toward the inguinal canal. The mass had no internal echoes and demonstrated increased through transmission (Figure 1
). Coronal and axial MR showed a thin walled cystic mass (Figure 2). At surgery, the round ligament with the cystic tense mass was excised. On gross inspection, the cyst communicated with the inguinal canal and appeared to communicate with the peritoneal cavity (Figure 3). Pathologic findings were consistent with a hydrocele of the canal of Nuck.
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Figure 1. A 7-year-old girl with hydrocele of the canal of Nuck. Ultrasound on the right inguinal area shows a comma-shaped cystic lesion with tail (arrows) directing cranially to the inguinal canal.
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Figure 2. MR findings of a hydrocele of the canal of Nuck. (a) Coronal T1 weighted and (b) axial T2 weighted images show the mass is true cystic and thin-walled in the right inguinal area.
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Figure 3. Photograph at surgery shows a comma-shaped cyst with surface beak continuing the round ligament that extends peritoneal cavity through the inguinal canal. The round ligament with cystic tense mass was excised by surgery.
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Discussion
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The canal of Nuck is the portion of the processus vaginalis within the inguinal canal in females. The processus vaginalis normally undergoes obliteration during the first year of life [1]. If obliteration fails in the distal portion of the canal, a sac containing serous fluid remains, the so-called hydrocele of canal of Nuck [1, 2]. Hydrocele of the canal of Nuck is rare condition. Clinically, the hydrocele of the canal of Nuck manifests as a painless swelling in the inguinal area and labium majus. The cysts are usually small averaging about 3 cm in length and about 0.3–0.5 cm in diameter [3]. A case report suggested that the ultrasound finding of a hydrocele of the canal of Nuck is typically sausage-shaped, extending along the route of the round ligament [2]. However, in our case, hydrocele of the canal of Nuck was comma-shaped with a surface beak representing a continuation of the peritoneal cavity through the inguinal canal on ultrasound. MR findings have not been previously described in the English literature. MR showed a hydrocele of the canal of Nuck as a thin-walled tense cystic mass in inguinal area. The differential diagnosis for inguinal masses in young female children, include indirect inguinal hernia, lymphadenopathy, Bartholin's cyst, and malignant and benign tumours. In conclusion, we suggest that a comma-shaped cyst with its tail directed cranially to the inguinal canal in the inguinal area of the young female children is suggestive of a hydrocele of the canal of Nuck.
Received for publication December 18, 2002.
Revision received April 22, 2003.
Accepted for publication June 11, 2003.
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References
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- Anderson CC, Broadie TA, Mackey JE, Kopecky KK. Hydrocele of the canal of Nuck: ultrasound appearance. Am Surg 1995;61:959–61.[Medline]
- Schwartz A, Peyser MR. Nuck's hydrocele. Int Surg 1975;60:91–2.[Medline]
- Block RE. Hydrocele of the canal of Nuck; a report of five cases. Obstet Gynecol 1975;4:464–6.
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Abstract
Introduction
