1979, British Journal of Radiology, 52, 624-625
Fetal hydrocele detected in utero by ultrasound By E. I. Miller, M.D. and R. H. Thomas, M.D. Hoag Memorial Hospital Presbyterian, 301 Newport Boulevard, Box Y, Newport Beach, California 92663, USA (ReceivedJune, 1978 and in revised form November, 1978) ABSTRACT
Demonstration of the fetal detail in utero has been more refined with advances in equipment and technical skill. Abdominal and genital abnormalities are being increasingly described. Presented are two cases of hydrocele diagnosed in utero.
Original demonstration of fetal detail by ultrasound was confined to gross neural abnormalities such as anencephaly and hydrocephalus. With refinement of equipment and increased technical expertise, abdominal and genital detail, both normal and pathological, has been described (Carroll, 1977; Lee and Blake, 1977; Lee and Warren, 1977; Schorzman, 1977; McQuown et al., 1975). Since hydroceles are not uncommon findings at birth and genitalia are being recognized more frequently, one would expect in utero diagnosis of hydroceles. Recently, two cases of bilateral fetal hydroceles were seen in our department as incidental findings. The patients had been referred for fetal dating. A unilateral hydrocele has been previously reported associated with fetal hydrops, pulmonary hypoplasia, and pleural effusions (Carroll, 1977). No fetal abnormalities at birth were found in either of our patients. Bilateral hydroceles were confirmed in both patients. CASE REPORTS
Case 1 A 23-year-old female was evaluated by ultrasound because of post-maturity. A single fetus with a biparietal diameter
Transverse scan which shows the hydroceles (S) and their relationship to the trunk (T) and a lower extremity (E).
which correlated with a term gestation was demonstrated. Both testicles were descended in a large transonic scrotum. No other abnormalities were found at birth in this term infant. Case 2 A 30-year-old female was evaluated with ultrasound on three occasions during her pregnancy. Examination at 11 and 32 weeks of gestation were unremarkable. The final examination was performed for post-maturity. A term gestation was diagnosed. Bilateral hydroceles were found and both testicles were descended. No other abnormalities were found at birth.
Transverse scans of the fetal abdomen are performed in the majority of our patients for cephalicabdominal ratio determination. The genitalia, when seen, most often show attachment to the perineum. The hydroceles in these cases were so large that they appeared separate from the fetuses. This produced some initial uncertainty until testicles were found in the enlarged scrotum of the fetus. Hydroceles may be communicating or noncommunicating depending on the patency of the processus vaginalis. Most of the time, they are incidental findings at birth. Hydroceles have been seen by others as well as ourselves in adults. These are the first bilateral fetal hydroceles described in the ultrasound literature. The clinical significance of fetal hydroceles is usually only incidental. Recently an infected hydrocele (pyocele) which required
FIG. 2. Longitudinal scan showing the bladder (B) and the hydroceles (S), and the apparent separation from the perineal tissues.
Fetal hydrocele detected in utero by ultrasound orchidectomy was described in a neonate (Jones and LEE, T. G., and BLAKE, S., 1977. Prenatal fetal ultrasonography and diagnosis. Radiology, 124, \T5-A11'. Deetes, 1975). LEE, T. G., and WARREN, B. H., 1977. Antenatal demonstraREFERENCES CARROLL, B., 1977. Pulmonary hypoplasia and pleural effusions associated with fetal death in utero. American Journal of Roentgenology, 129, 749-750. JONES, W. G., and DEETES, J. H., 1975. Infected hydrocele in
a neonate. Urology, 5, 526-527.
tion of fetal bowel. Radiology, 124, 471-474. MCQUOWN, D., FISHBEIN, M., MORAN, E. T., and HOFFMAN,
R. B., 1975. Abdominal cystic lymphangiomatosis, report of a case involving the liver and spleen. Journal of Clinical Ultrasound, 3, 291-296. SCHORZMAN, L., 1977. Sex determination in utero. Medical Ultrasound, 1, 25—26.
Book review Clinical Biostatistics. By Alvan R. Feinstein, pp. xii + 468, 1977 (St. Louis, C. V. Mosby Co.) Paperback £10-75. Most doctors read and many write, It thus becomes essential quite That all acquire some sort of knowledge About statistics at their college, Lest later on their publications Give rise to muttered imprecations.
"Statistical procedures never Prove anything"—but by a clever Manipulation of your data Show that the risk of chance is greater Than the result you hoped to show (And then they say—"I told you so!") So we are warned the reasons why One should beware the square of chi.
Professor Feinstein in this book Has had a long and careful look At methods used by statisticians To aid (maybe confuse) clinicians. But do not think the cunning Prof. Does nothing more than sneer and scoff: He shows how two and two make four—Or if they don't, how to explore The reasons for this grave omission— A subject for great erudition.
Full chapters look at the design Of therapeutic trials, and shine Some light on diagnostic tests To show just where their value rests. Controls and bias are displayed, With cautions too on studies made On past and future generations And why we use stratifications. All these and other points reveal How to advance the common weal.
Based upon lectures though this text Is repetitious; one is vexed By turgid prose and places too Where fewer words would really do. There's no remission to enchant From diagrams or tables scant. Despite these drawbacks some would gain To read right through, and yet again Some part could well be read by all With benefit beyond recall.
A minor pearl of wit I found And trials clinical expound— "An exercise where a clinician With methods from a statistician (Which doctors don't quite understand) He draws conclusions that must stand From data that are still unclear To statisticians far and near." And if the answers be expressed In SI units—all is blessed By Editors. Alas, that we Such suckers simple seem to be!
Read by the sturdy devotee Some simple truths emerge, e.g., "Like only with like should compare" (Yet some are more alike I swear): "Patients choose doctors"—the reverse But seldom happens—that's the curse That from a morbid population The "rancid sample" has causation.
The print is clear and well provided With indices which are divided For authors, methods, and examples To help you get those "random samples". GODFREY PRICE.