In adults with hydrocele, which history clue suggests a secondary cause?

• A. Congenital presentation in infancy
• B. Painless swelling since birth
• C. History of injury, infection, or inflammatory etiologies
• D. Transillumination negative

Answer: (C)

In adults, hydroceles can be primary (idiopathic or related to congenital persistence) or secondary to another scrotal process. A history of injury, infection, or inflammatory conditions points to a secondary hydrocele because these events can trigger inflammation or fluid accumulation around the testis. By contrast, congenital presentations or swelling since birth suggest a primary congenital hydrocele rather than a secondary one. Transillumination relates to exam findings rather than history; a hydrocele usually transilluminates, but a negative result would raise concern for other conditions rather than indicate a secondary etiology.