brand logo

Am Fam Physician. 2022;106(5):571-572

Author disclosure: No relevant financial relationships.

A 53-year-old man presented with concerns about swelling in his scrotum. The swelling appeared approximately three years earlier and had been increasing in size. It was painless and did not affect his walking, urination, erections, or ejaculation. He had no urethral discharge.

Physical examination revealed a left-sided scrotal mass (Figure 1) that was mobile, spongy, and ovoid. It was superior to the testicle and roughly twice the size. With the room lights turned off, an otoscope shined on the mass showed transillumination (Figure 2).


Based on the patient’s history and physical examination findings, which one of the following is the most likely diagnosis?

  • A. Epidermoid cyst.

  • B. Hydrocele.

  • C. Inguinal hernia.

  • D. Testicular cancer.

  • E. Varicocele.


The answer is B: hydrocele. Hydroceles are benign masses that gradually form in the scrotum. They present as ovoid, nontender, mobile scrotal masses located superior or adjacent to the testicle. They consist of a persistent section of the processus vaginalis or tunica vaginalis and contain clear fluid. Hydroceles may appear at any age but are common in newborns, resolving in the first year of life. They are usually unilateral and appear insidiously. Hydroceles that form from a persistent processus vaginalis are situated superior to the testicle, and those that develop from the tunica vaginalis may overlap and obscure the adjacent testicle. In adults, hydroceles may result from conditions that cause lymphatic obstruction, including filariasis in tropical regions.1

Already a member/subscriber?  Log In


From $165
  • Immediate, unlimited access to all AFP content
  • More than 130 CME credits/year
  • AAFP app access
  • Print delivery available

Issue Access

  • Immediate, unlimited access to this issue's content
  • CME credits
  • AAFP app access
  • Print delivery available
Purchase Access:  Learn More

The editors of AFP welcome submissions for Photo Quiz. Guidelines for preparing and submitting a Photo Quiz manuscript can be found in the Authors' Guide at To be considered for publication, submissions must meet these guidelines. Email submissions to

This series is coordinated by John E. Delzell Jr., MD, MSPH, associate medical editor.

A collection of Photo Quiz published in AFP is available at

Continue Reading

More in AFP

More in PubMed

Copyright © 2022 by the American Academy of Family Physicians.

This content is owned by the AAFP. A person viewing it online may make one printout of the material and may use that printout only for his or her personal, non-commercial reference. This material may not otherwise be downloaded, copied, printed, stored, transmitted or reproduced in any medium, whether now known or later invented, except as authorized in writing by the AAFP.  See permissions for copyright questions and/or permission requests.