Pathophysiology of the Canal of Nuck
- Extension of the parietal peritoneum follows the round ligament as it passes to the inguinal canal.
- Usually gets obliterated.
- This evagination of the parietal peritoneum = the canal of Nuck = female counterpart of processus vaginalis in men.
- If it is:
- Completely patent: Avenue for an indirect inguinal hernia and hydrocele (Canal of Nuck hernia).
- Obliterated at the level of both the superficial and deep inguinal rings: Fluid may be trapped in between both ends of the canal, creating a Canal of Nuck cyst.
- Obliterated at lower end – Infantile hydrocele / encysted hydrocele.
- Hydrocele vs cyst canal of Nuck : The terms hydrocele and cyst of Canal of Nuck are used interchangeably but these are separate pathologies.
- Symptoms: It usually presents as a painless swelling in the inguinal region. Infection can cause pain.
Imaging appearances:
- Canal of Nuck cyst is an inguinal cyst in females.
- US : Cystic lesion in the inguinal canal with posterior acoustic attenuation.
- CT : Hypodense lesion with our without internal septations.
- MRI: T1 isointense, T2 hyperintense, typical appearance of a cystic lesion.
- Can show peripheral enhancement.
Differentials for Canal of Nuck cyst
- Inguinal hernia containing fluid in patients with ascites.
- Soft tissue tumor.
- Endometriosis cyst
- Cyst
- Abscess
- Lymphadenopathy
Management:
Surgical excision or conservative management depending on patient presentation.
Detailed video with PACS based case images:
Last Updated on August 14, 2020
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About the Author
Dr. Amar Udare, MD, DNB
Dr. Amar Udare is a board-certified radiologist. He is currently working as a fellow radiologist at McMaster University, Canada. He has a passion for teaching (#FOAMrad and #FOAMed) and has been a semi-finalist for the 2018 and 2020 Aunt-Minnie Most effective Radiology Educator Awards. He has authored multiple peer-reviewed publications which can be accessed on PubMed and Google Scholar.
