35 year old multiparous lady presented with a relatively painless right inguinolabial swelling. Ultrasound identified a fluid filled inguinal lesion raising suscpicion of indirect inguinal vs femoral hernia. A contrast enhanced CT study was done.
Oral postivie contrast followed by i.v. iodinated contrast administration and portovenous phase acquisition.
Annotated curved planar reconstruction
Non enhancing thin walled cystic lesion seen intra abdominal in right inguinal region in relation to round ligament tracking caudally through the inguinal canal. Cylindrical fluid component seen in the canal extending via the superficial ring just into the labium. No associated omental fat or bowel contents.
Indirect inguinal hernias are not uncommon in females, and usually tends to contain omentum or bowel as content. Less common contents include ovary, ovarian cysts, fallopian tube or urinary bladder.
The purely fluid nature of the lesion combined with a communicating larger abdominal component favors the possibility of a hydrocele of patent processus vaginalis rather than an indirect inguinal hernia. The ipsilateral ovary and tube, adjacent bowel loops and omentum remain abdominal with no extension into the inguinal canal.