That looks painful: Hydrocele

Case presentation

A 4-month-old male presents with bilateral scrotal swelling. Per the mother, this has been present since 1 month of age but has worsened over the past week and she has noted that the right side of the scrotum appears darker than normal. The mother also states that there has been mild congestion and cough for the past week and today the child developed a fever to 102.5 degrees Fahrenheit. There have been no other symptoms, including vomiting, diarrhea, rash, or fussiness. He has been drinking well. His physical examination reveals a temperature of 101 degrees Fahrenheit, a respiratory rate of 30 breaths per minute, and a heart rate of 120 beats per minute. He is very well appearing and in no distress. He has mild nasal congestion with normal tympanic membranes. His lungs are clear. His abdominal examination is unremarkable; there is no apparent tenderness, masses, or hepatosplenomegaly. His genital examination shows an uncircumcised male with the scrotum markedly enlarged bilaterally making the examination difficult. There is no erythema; there are no palpable masses; there is induration but no palpable fluctuance. Transillumination of the scrotum reveals probable fluid.