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JAMA Clinical Challenge |

Lower Abdominal Swelling and Scrotal Enlargement

Huan J. Chang, MD, MPH
JAMA. 2011;306(15):1709-1710. doi:10.1001/jama.2011.1434.
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A 24-year old man reports progressive, right lower abdominal swelling and right scrotal enlargement over 2 years. He denies any pain or sudden changes in the size of the swelling. There is no history of trauma or urinary symptoms. Physical examination reveals a smooth, fluctuant, right abdominal swelling extending from the level of the umbilicus to the inguinal ligament (Figure 1). There is also a smooth, cystic swelling causing marked enlargement of the right half of the scrotum. There is no local warmth or tenderness. The left testis is within the scrotum, but the right testis is not palpable. When the patient is asked to cough, there is a palpable thrill. Palpation of the abdominal and scrotal swellings simultaneously reveals cross-fluctuation. Both the swellings are transilluminant.

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Figure 1. Right lower abdominal and right scrotal swelling (figure reprinted from Arch Surg. 2011;146[6]:757-7581).
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Figure 2. Computed tomographic scan (coronal section) shows the cystic abdominal swelling in continuity with the scrotal swelling (figure reprinted from Arch Surg. 2011;146[6]:757-7581).
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