The newborn baby boy in this vignette was found to have a hydrocele. Most hydroceles will resolve within the first 12 months of life and do not need to be reassessed unless present after 1 year.
Hydroceles are scrotal enlargements secondary to fluid collections. A failure of the embryonic processus vaginalis to close allows abdominal fluid to enter the scrotum. Fluid collections can be serous, blood (hematocele), or sperm (spermatocele). Transillumination differentiates between testicular masses and hydroceles. A hydrocele does not need to be surgically treated unless it does not spontaneously remit over the course of the child's first year of life. For most hydroceles, watchful waiting is an appropriate management. If the hydrocele does persist beyond 12 months, surgery is recommended in order to decrease the future risk of inguinal hernias.
Zornow et al. discuss scrotal pathology and the proper physical examination of the scrotum. Inspection, palpation, and transillumination (if indicated) are the techniques used in a proper exam of the scrotum. Check for hypoplastic testicles, whether they have both descended, or any masses that may be concerning. The classic "bag of worms" noted on physical exam is indicative of a varicocele.
Lao et al. report on pediatric hydroceles. The incidence of hydroceles are inversely related to the age of the child. A noncommunicating hydrocele is when there is complete obliteration of the proximal portion but patency of the processus. On the other hand, communicating hydroceles are due to a narrowing but incomplete closure of the proximal processus. Communicating hydroceles fluctuate in size throughout the day and with manual compression, which helps to differentiate them from the noncommunicating type.
Illustration A is a figure depicting the various types of hydrocele. Illustration B demonstrates what transillumination looks like in a child with a hydrocele.
Answers 1-4: None of these time frames are correct. The parents should practice watchful waiting of the hydrocele for up to 1 full year. If after 1 year the hydrocele remains, they should seek reassessment by a physician for possible surgical management.
Zornow DH, Landes RR. Scrotal palpation. Am Fam Physician. 1981 Jan;23(1):150-4.
PMID:6109445 (Link to Abstract)
Lao OB, Fitzgibbons RJ Jr, Cusick RA. Pediatric inguinal hernias, hydroceles, and undescended testicles. Surg Clin North Am. 2012 Jun;92(3):487-504, vii. doi: 10.1016/j.suc.2012.03.017. Review.
PMID:22595705 (Link to Abstract)