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E1971. Imaging Features of Canal of Nuck Hydroceles in Adult Females
Authors
  1. Eseosa Bazuaye-Ekwuyasi; University of Texas Medical Branch
  2. Peeyush Bhargava; University of Texas Medical Branch
  3. Henry Bushey; JPS Health Network; University of Texas Medical Branch
  4. Oyintonye Odogwu-Hall; University of Texas Medical Branch
  5. Alvin Camacho; University of Texas Medical Branch
Background
Hydrocele of the canal of Nuck is a rare cause of vulvar swelling, proposed to account for 5-12% [1] of inguinolabial/vulvar swellings. They include encysted hydrocele of the canal of Nuck, communicating hydrocele and bilobed hydrocele. Imaging can establish a diagnosis in these cases.

Educational Goals / Teaching Points
In this exhibit, we review the embryology and anatomy of the inguinal canal and explain the pathophysiology of canal of Nuck hydroceles. A multi-modality review of the imaging features of different subtypes of canal of Nuck hydroceles will also be presented.

Key Anatomic/Physiologic Issues and Imaging Findings/Techniques
The processus vaginalis which plays a major role in the embryologic development of the inguinal canal in females undergoes complete obliteration by the first year of life [2]. Failure of complete closure of the processus vaginalis is referred to as a patent processus vaginalis, also called the canal of Nuck; named after the Dutch anatomist Anton Nuck who first described it in 1691 [3]. Abnormalities of the canal of Nuck can be classified into congenital indirect hernias or hydroceles. Hydroceles of the canal of Nuck comprise of encysted hydrocele of the canal of Nuck, communicating hydrocele and bilobed hydrocele [1, 4, 5]. On sonographic examination, canal of Nuck hydroceles usually appears as a thin-walled, well-defined anechoic, avascular mass in the inguinal area or labia [4,6]. Computed tomography and Magnetic resonance can adequately depict the anatomy and characteristics of Canal of Nuck Hydroceles. Cross-sectional imaging is also useful in demonstrating possible communication with the peritoneal cavity, as in communicating hydroceles; or the presence of an associated intra-abdominal fluid collection in the case of bilocular hydrocele [1, 2, 4].

Conclusion
Although abnormalities of the canal of Nuck are not frequently encountered, it is important for radiologists to identify this uncommon entity accurately. Cross-sectional imaging can provide a definitive diagnosis in these cases by delineating the contents of the patent processus vaginalis, establishing communication with the peritoneum, and differentiating canal of Nuck hydroceles from other more common causes of inguinolabial swellings.