Spermatic cord lipoma

[Anonymous]

Dear Stephen,

I learned from your lecture that never ever mistaken spermatic cord lipoma for a positive inguinal hernia, based on the movement at deep ring. I came across a case where there is distension of the superficial ring cause by a hypoechoic fat tissue during valsalva, but no discernible movement at deep ring. And I learned that spermatic cord lipoma is actually protrusion of extraperitoneal fat. Should I see the neck of the ‘fat’ at the deep ring? For my case, both sides appear the same, making me wondering is this spermatic cord lipoma or real indirect hernia?
Thank you.

[Stephen Bird]

This does not look or sound like a hernia. I think it is some fat sitting around the spermatic cord. If it was a hernia it would grow with straining and you would see distention of the deep ring or a defect in the posterior wall. This case sounds like a little fat sitting in the canal and sliding small distances with straining.
I am going for cord lipoma rather than a hernia.
Steve

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