Hydrocele of the canal of Nuck: a case report with magnetic resonance hydrography findings

Abstract

Hydrocele of the canal of Nuck, also called the “female hydrocele,” is a rare developmental disorder in females. This entity is now believed to be more common now in comparison with previous reports; however, it is still an unfamiliar problem for physicians. The processus vaginalis accompanies the round ligament through the inguinal canal into the labium majus. This evagination of the parietal peritoneum forms the canal of Nuck in the female. The canal of Nuck normally loses its connection with the peritoneal cavity during the first year of life, but can result in a hernia or hydrocele when the connection of the canal of Nuck fails to close. Here, we present the case of a 43-year-old female who complained of swelling in the right inguinal region. Coronal and axial magnetic resonance imaging (MRI) revealed a cystic mass lesion with an irregular shape in the right inguinal region, and smaller cystic lesions extending alongside the right round ligament were also identified in the right side of the pelvic cavity. Magnetic resonance (MR) hydrography revealed the uninterrupted cystic lesion from the inguinal region to the pelvic cavity, with constrictions at the internal and external inguinal rings. These MR findings proved to be incredibly useful for surgical planning.

Hydrocele of the canal of Nuck presenting as a sausage-shaped mass

“…Some cases are preoperatively misdiagnosed as inguinal hernias and Bartholin cysts or abscesses,3 which are the leading causes for differential diagnostic.…”

“…This evagination of the parietal peritoneum is the canal of Nuck, analogous of the processus vaginalis in the male 19. During the first year of life, it is expected that this peritoneal evagination obliterates 3. However, if it remains patent, forms a pouch of peritoneum in the labia majora.…”

Cyst of the Canal of Nuck in adult females: A case report and systematic review

“…High-resolution real-time sonography serves as an inexpensive and accurate modality for differentiating hydrocele of the Canal of Nuck from the aforementioned conditions. In an ultrasound scan, Nuck cyst appears as a thin walled, tubular or dumbbell shaped, well defined, anechoic or hypoechoic, unilocular or multilocular cystic structure (19,22). In a colour Doppler scan, the Nuck cyst does not show any internal vascularity (28,29).…”

“…Additionally, an MRI may also be performed, particularly in complicated cases, such as those involving additional pathologies where hydrocele usually appears as a well-defined, thin-walled cystic lesion in hypointense on T1-weighted and hyperintense on T2-weighted series (1). Imaging with MRI allows for good visualization of the anatomic structures surrounding the cyst, communication between the cyst and the peritoneal cavity and the extension of the cyst of the Canal of Nuck (22). However, despite the utility of imaging in differential diagnosis, surgery along with histological and immunohistological analysis of the excised mass is required for a more conclusive diagnosis of a Nuck cyst.…”

“…Postoperative recovery was uneventful, and no postoperative deaths or complications were observed. According to 7 of the included studies, no recurrence of the lesion was reported in the follow up period, which ranged from 2-24 months after surgery (3,8,9,16,18,20,22). Data concerning hospital stay was reported in 4 studies with a range of 20-72 h (7,10,18,20).…”