--- title: A 2-year old boy presents to the ED with left hemiscrotal swelling description: It's Hemiscrotal Swelling Quiz Time with Med-Challenger! image: https://challengercme.com/hubfs/image%20(70).png --- [![Med-Challenger-green-logo-1024x244](https://challengercme.com/hubfs/Med-Challenger-green-logo-1024x244.webp) ](https://challengercme.com/) - [SHOP EXAM PREP & CME ](https://challengercme.com/blog/a-2-year-old-boy-presents-to-the-ed-with-left-hemiscrotal-swelling#) ### [EMERGENCY MEDICINE](https://challengercme.com/emergency-medicine-exam-review-cme-course) [ABEM exam prep](https://challengercme.com/emergency-medicine-exam-review-cme-course), [MyEMCert](https://challengercme.com/emergency-medicine-myemcert-exam-review-course), etc. ### [FAMILY MEDICINE](https://challengercme.com/family-medicine-exam-review-cme-course) [ABFM exam prep](https://challengercme.com/family-medicine-exam-review-cme-course), [ABFM KSA](https://challengercme.com/family-medicine-moc-ksa-course), etc. ### [INTERNAL MEDICINE ABIM exam prep, MOC points, etc.](https://challengercme.com/internal-medicine-exam-review-cme-course) ### [OBGYN ABOG exam prep, CREOG, etc.](https://challengercme.com/obgyn-exam-review-cme-course) ### [PEDIATRICS ABP exam prep, MOCA-PEDS, etc.](https://challengercme.com/pediatric-medicine-exam-review-cme-course) ### [PEDIATRIC EM](https://challengercme.com/pediatric-emergency-medicine-3rd-edition) [ABP/ABEM exam prep Ed.3](https://challengercme.com/pediatric-emergency-medicine-3rd-edition), [Ed.2](https://challengercme.com/pediatric-emergency-medicine-pack2), etc. ### [SPECIAL PURPOSE / SPEX FSMB exam prep, etc.](https://challengercme.com/special-purpose-exam-review-spex-exam-preparation-course) ### [PHYSICIAN ASSISTANT](https://challengercme.com/physician-assistant-exam-review-cme-course) [PANCE / PANRE](https://challengercme.com/physician-assistant-exam-review-cme-course), [CAQ-EM](https://challengercme.com/pa-caq-em-review-course), etc ### [NURSE PRACTITIONER](https://challengercme.com/family-nurse-practitioner-exam-review-cme-course) [FNP](https://challengercme.com/family-nurse-practitioner-exam-review-cme-course), [ENP](https://challengercme.com/emergency-nurse-practitioner-exam-review-cne-course), [AGNP](https://challengercme.com/adult-gerontology-nurse-practitioner-exam-review-cne-course), [PNCB/CPNP](https://challengercme.com/pediatric-nurse-practitioner-exam-review-cne-course), etc. ### [NURSING / NCLEX NCLEX, CNE, etc.](https://challengercme.com/nursing-certification-nclex-exam-review-cne-courses) ### [STATE-REQUIRED CME / CE State CME requirements, etc.](https://challengercme.com/state-required-cme) ### [JOINT COMMISSION CME](https://challengercme.com/stroke-center-ce-review-course) [Stroke](https://challengercme.com/stroke-center-ce-review-course), [Cardiac](https://challengercme.com/cardiac-center-ce-review-course), [Trauma](https://challengercme.com/trauma-center-ce-review-course), [ALS](https://challengercme.com/advanced-life-support-and-resuscitation-center-ce-review-course), etc. ### [PROFESSIONALISM CME Professionalism review with CME](https://challengercme.com/professionalism-review-course) ### [DERMATOLOGY CME Dermatology review with CME](https://challengercme.com/dermatology-review-course) ### [USMLE STEP 2CK / STEP 3 USMLE exam prep, etc.](https://challengercme.com/usmle-certification-exam-review-clerkship-exams-shelf-exam-review) - [INSTITUTIONS ](https://challengercme.com/atlas-pro-inst) - [BLOG ](https://challengercme.com/blog) - [SUPPORT ](https://support.challengercme.com/knowledge) [SIGN IN ](https://fuse.challengercme.com/sign-in?redirectURL=%2Fuserdash) pediatric emergency medicine # A 2-year old boy presents to the ED with left hemiscrotal swelling It's Hemiscrotal Swelling Quiz Time with Med-Challenger! [ Med-Challenger ](https://challengercme.com/blog/author/med-challenger) Jan 24, 2025 [pediatric emergency medicine](https://challengercme.com/blog/tag/pediatric-emergency-medicine) [Personal Education](https://challengercme.com/blog/tag/personal-education) [Question of the Week](https://challengercme.com/blog/tag/question-of-the-week) [quick quiz](https://challengercme.com/blog/tag/quick-quiz) ### < [All Posts](https://challengercme.com/blog) Exam Prep + CME Med-Challenger Peds EM Pass-guaranteed PEDS EM exam review with CME built-in. Try it for free. 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The parents have noticed intermittent mild swelling over the past several weeks, but tonight in the bath, they noticed that the swelling was significantly larger. The patient seems a little uncomfortable to the parents, but he has not had any vomiting, fever, or difficulty urinating. His exam is notable for tense left hemiscrotal swelling. Cremasteric reflexes are intact, and the testicular lie is vertical, but it is difficult to assess the size of the testis due to the swelling. There is no overlying discoloration. An ultrasound is obtained with an image shown below. ![image (70)](https://challengercme.com/hs-fs/hubfs/image%20(70).png?width=800&height=475&name=image%20(70).png) *Photo courtesy of Kathleen Kieran, MD* What is the most appropriate next step? - Arrange for a testicular biopsy as an outpatient - Follow up with a surgeon for elective repair - No further work-up or management is indicated - Obtain a urinalysis with culture The correct answer is: Follow up with a surgeon for elective repair Follow up with a surgeon for elective repair. This US demonstrates a hydrocele, a communication of fluid around the testicle within the tunica vaginalis. The history of intermittent swelling is consistent with a communicating hydrocele. While most spontaneously resolve by age 18 months, persistence at age 2 years is an indication for surgical repair. A biopsy would be indicated for concern for testicular tumor, but without masses palpated on exam or abnormal findings on US, this is not indicated. Urinalysis and culture are not useful in this scenario. [5-Min PEM pp 458-9]   This question appears in [Med-Challenger Pediatric Emergency Medicine 3rd Edition Exam Review with CME](https://challengercme.com/pediatric-emergency-medicine-3rd-edition) [Try for free and save](https://fuse.challengercme.com/fulltrial/233). Ace your exams and meet your CME/MOC requirements. 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All rights reserved [Privacy Policy](https://support.challengercme.com/knowledge/what-are-your-terms-of-service-privacy-policy-user-agreement) ```json { "@context" : "https://schema.org", "@id" : "https://challengercme.com/blog#webpage", "@type" : "WebPage", "description" : "The Challenger Medical Education Blog offers informative patient cases, medical certification exam preparation courses and board exam review tips.", "inLanguage" : "en", "isPartOf" : { "@type" : "WebSite", "name" : "Med-Challenger", "url" : "https://challengercme.com/" }, "mainEntityOfPage" : { "@id" : "https://challengercme.com/blog", "@type" : "WebPage" }, "name" : "Challenger Medical Education Blog", "primaryImageOfPage" : { "@type" : "ImageObject", "url" : "https://challengercme.com/hubfs/Webpage%20Featured%20Images/Medical%20Education%20Blog%20-%20Free%20CME%20resources%2c%20certification%20exam%20tips%2c%20clinical%20challenge%20questions%20and%20more.png" }, "publisher" : { "@type" : "Organization", "name" : "Challenger Corporation", "url" : "https://challengercme.com/" }, "url" : "https://challengercme.com/blog" } ``` ```json { "@context" : "https://schema.org", "@type" : "Article", "about" : [ "hydrocele", "communicating hydrocele", "pediatric scrotal swelling", "testicular ultrasound", "testicular exam (cremasteric reflex, testicular lie)", "surgical repair (elective)", "exam preparation", "medical education", "CME/MOC" ], "articleSection" : "Pediatric Emergency Medicine", "author" : { "@type" : "Organization", "name" : "Challenger Corporation" }, "dateModified" : "2025-01-24T15:07:42.749Z", "datePublished" : "2025-01-24T15:07:42.000Z", "description" : "It's Hemiscrotal Swelling Quiz Time with Med-Challenger!", "headline" : "A 2-year old boy presents to the ED with left hemiscrotal swelling", "image" : [ { "@type" : "ImageObject", "description" : "Ultrasound image demonstrating a hydrocele (photo courtesy of Kathleen Kieran, MD)" } ], "inLanguage" : "en-US", "keywords" : [ "hydrocele", "communicating hydrocele", "pediatric", "scrotal swelling", "testicular ultrasound", "surgical repair", "exam prep", "Med-Challenger" ], "mainEntityOfPage" : { "@id" : "https://challengercme.com/blog/a-2-year-old-boy-presents-to-the-ed-with-left-hemiscrotal-swelling", "@type" : "WebPage" }, "publisher" : { "@type" : "Organization", "logo" : { "@type" : "ImageObject", "url" : "https://challengercme.com/logo.png" }, "name" : "Challenger Corporation" } } ``` ```json { "@context" : "https://schema.org", "@type" : "QAPage", "mainEntity" : { "@type" : "Question", "acceptedAnswer" : { "@type" : "Answer", "text" : "Follow up with a surgeon for elective repair. The ultrasound and history are consistent with a communicating hydrocele; intermittent swelling fits a communicating process. Because most communicating hydroceles that persist beyond about 18 months do not resolve spontaneously, persistence at age 2 is an indication for surgical repair. Testicular biopsy and urinalysis/culture are not indicated given the exam and ultrasound findings." }, "name" : "Most appropriate next step for a 2-year-old with left hemiscrotal swelling?", "text" : "A 2 yo boy presents with intermittent mild left hemiscrotal swelling that became larger tonight. He has no vomiting, fever, or difficulty urinating. Exam: tense left hemiscrotal swelling, cremasteric reflexes intact, vertical testicular lie, no overlying discoloration. Ultrasound image shown demonstrates a hydrocele. What is the most appropriate next step? Options: Arrange for a testicular biopsy as an outpatient; Follow up with a surgeon for elective repair; No further work-up or management is indicated; Obtain a urinalysis with culture." } } ``` ```json { "@context" : "https://schema.org", "@type" : "ItemList", "description" : "Exam-style review questions based on this article’s teaching points.", "itemListElement" : [ { "@type" : "ListItem", "item" : { "@type" : "Question", "acceptedAnswer" : { "@type" : "Answer", "text" : "Hydrocele (communicating hydrocele). Intermittent swelling is consistent with a communicating hydrocele, and persistence at age 2 is an indication for elective surgical repair." }, "name" : "What diagnosis is suggested by ultrasound showing fluid around the testicle in a 2-year-old with intermittent scrotal swelling?" }, "position" : 1 } ], "name" : "Practice Questions", "numberOfItems" : 1 } ```