The presence of fluid is demonstrated by transillumination. These hydroceles can reach a huge size, containing large amount of fluid, as these are painless and are often ignored. They are otherwise asymptomatic, other than size and weight, causing inconvenience. However the long continued presence of large hydroceles causes atrophy of testis due to compression or by obstructing blood supply. In most cases, the hydrocele, when diagnosed early during complete physical examination, are small and the testis can easily be palpated within a lax hydrocele. However Ultrasound imaging is necessary to visualize the testis if the hydrocele sac is dense to reveal the primary abnormality. But these can become large in cases when left unattended. Hydroceles are usually painless, as are testicular tumors. A common method of diagnosing a hydrocele is by attempting to shine a strong light (transillumination) through the enlarged scrotum. A hydrocele will usually pass light, while a tumor will not (except in the case of a malignancy with reactive hydrocele). Secondary hydroceles
Secondary hydroceles due to testicular diseases can be the result of cancer, trauma (such as a hernia), or orchitis (inflammation of testis), and can also occur in infants undergoing peritoneal dialysis. A hydrocele is not a cancer but it should be excluded clinically if a presence of a testicular tumor is suspected, however, there are no publications in the world literature that report a hydrocele in association with testicular cancer. Secondary hydrocele is most frequently associated with acute or chronic epididymo-orchitis.
Sponastrime dysplasia is a rare condition characterised by facial and skeletal abnormalities. Signs and symptoms
The main features of this condition are evident in skeleton and face.Facial features:

Macrocephaly
Frontal bossing
Midface hypoplasia
Depressed nasal root
Small upturned nose
PrognathismSkeletal features:

Shortened limbs (more pronounced in lower limbs)
Short stature
Progressive coxa varaOn X ray:

Abnormal vertebral bodies (particularly in the lumbar region)
Avascular necrosis of the capital femoral epiphyses
Striated metaphyses
Generalized mild osteoporosis
Delayed ossification of the carpal bonesOther associated conditions:
These are variably present
Cataracts
Hypogammaglobulinemia
Intellectual disability
Short dental roots
Subglottic stenosis
Tracheobronchomalacia

Genetics
This condition has been associated with mutations in the Tonsoku-like, DNA repair protein (TONSL) gene. This gene is located on the long arm of chromosome 8 (8q24.3). This gene is also known as NFKBIL2. Pathopysiology
This is not understood. It appears that the TONSL gene product is involved in genome repair. Diagnosis
This can be suspected when the usual facial and skeletal features are present. It is confirmed by sequencing the TONSL gene. Differential diagnosis
Short limbed dwarfism syndrome in association with immunodeficiency. Treatment
There is no specific treatment for this condition. Management is supportive. Epidemiology
This condition is considered to be rare with less than 100 cases reported in the literature. History
This condition was first described in 1983. == References ==