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Pelvis » Scrotum And Testicles
Tunica albuginea cyst
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Author(s) :
Chaitali Shah, FRCR
Presentation A 32 year old male presented for a follow up testicular ultrasound. He had an initial scan performed for a palpable left scrotal swelling.
Caption: Transverse scan of the left testis
Description: A well-defined cystic structure is seen within the left tunica albuginea overlying the upper pole of the testis. This was subcentimeter in size.
Caption: Sagittal scan of the left testis
Description: The simple cystic structure is noted again in this image. Of note is the characteristic lateral location.
Differential Diagnosis Tunica albuginea cyst, simple intra-testicular cyst
Final Diagnosis Tunica albuginea cyst
Discussion The tunica albuginea is a fibrous layer that closely envelops the testis. Tunica albuginea cysts are small simple cystic structures, usually less than a centimeter in size, may be loculated and are easily palpable due to their subcapsular location. They are classically peripherally located close to the upper and anterior border of the testis. 

The exact etiology of these cysts is unknown, although congenital, traumatic and post-infectious etiologies have been postulated.

The closest differential for this entity is a simple intra-testicular cyst and sometimes if the cysts are large, it may be difficult to distinguish the two by ultrasound alone. Intra-testicular cysts however, also have typical locations - close to the rete testis and are rarely clinically palpable.

High resolution ultrasonography of the scrotum is helpful in arriving at a diagnosis and in follow up of these cases.
Case References 1. Dogra VS, Gottlieb RH, Rubens D, Liao L. Benign intratesticular cystic lesions: US features. Radiographics 2001; 21:S273-S281.
Follow Up This patient has been followed for 3 years with no change in the size of the cyst.
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