Diagnosis of Epididymitis
Epididymitis Diagnosis: Book Excerpts
Diagnostic Tests for Epididymitis: Online Medical Books
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Testicular Pain:
Differential Diagnosis
(In a Page: Signs and Symptoms)
-
Epididymitis
–Insidious onset of symptoms seen in adolescent (postpuberty) boys
–Bacterial (e.g., Chlamydia, Enterobacter) versus viral (mumps, mononucleosis, adenovirus) -
Testicular torsion
–Twisting of the spermatic cord results in testicular ischemia
–Acute onset of severe pain, diffuse tenderness
–Negative urinalysis; absent cremasteric reflex
–Testes on affected side are tender, shortened, and lie transversely
–Duration of ischemia (time until detorsion is completed) determines the viability of the affected testicle
-
Hydrocele
–A collection of fluid between the layers of the tunica vaginalis; usually nontender
-
Varicocele
–Palpated as a “bag of worms” above testes
–Dull ache exacerbated by strenuous
exercise; left >right
-
Epididymal or testicular appendage torsion
–Subacute onset seen in prepubertal boys
–Localized to the upper pole of testicle
–Negative U/A; normal cremasteric reflex
-
Ruptured abdominal aortic aneurysm
-
Peritonitis
-
Referred pain due to an incarcerated hernia, constipation, or kidney stone
-
Scrotal trauma
–Results from a direct blow or saddle injury
–May result in traumatic epididymitis,
hematocele, or laceration of the tunica albuginae (testicular rupture)
-
Fournier's gangrene
–Necrotizing fasciitis of the perineum
–Seen primarily in older men - Henoch-Schönlein purpura
–Systemic vasculitis resulting in scrotal pain, abdominal pain, arthralgias, nonthrombocytopenic purpura, and renal disease
–Occurs in prepubertal boys - Tumor
–Painless scrotal mass is a testicular
neoplasm until proven otherwise
Workup and Diagnosis
- History and physical examination including abdomen, back, genitalia, and digital rectal examination
–Note character of onset (sudden or subacute), duration (minutes, hours, or days), location (generalized or localized), quality (sharp or dull, moderate or severe, constant or intermittent), and previous episodes
–Palpate testicle and spermatic cord to assess for tenderness, effusion, subcutaneous emphysema, size, and lie of testicle, and assess for hernias
–Transilluminate for presence of fluid
–“Blue dot sign”: Bluish discoloration along upper pole seen in about 20% of cases of torsion of the testicular appendix and due to infarction and necrosis
–“Prehn's sign”: Relief of pain with elevation of the testis in testicular torsion
-
If testicular torsion is suspected, emergent detorsion is necessary, generally by a urologic specialist
-
Culture for Neisseria gonorrhoeae and Chlamydia trachomatis in sexually active males before urinalysis
-
Urinalysis in all patients: Elevated WBC or RBC levels suggest infection (e.g., epididymitis)
-
Ultrasound of the testicles using color Doppler measures blood flow and evaluates for masses
-
Radionucleotide scintigraphy may also be used to assess blood flow
-
Recent studies have advocated the use of MRI
» READ BOOK EXCERPT ONLINE »
Source: In a Page: Signs and Symptoms, 2004
TESTICULAR PAIN:
Approach to the Diagnosis
(Differential Diagnosis in Primary Care)
The approach to the diagnosis of testicular, pain involves searching for a mass; if it is present, certain questions must be answered. Does it transilluminate (hydrocele)? Can one get above the swelling (testicular mass)? Is it reducible (hernia)? Does supporting the testicle relieve the pain (torsion)? A search for prostatic hypertrophy or prostatitis should be made, particularly in older men. Smears of urethral discharge, urinalysis and urine culture, cystoscopy, and an IVP may be indicated in selected cases. An exploration for torsion or hernia may be the only way to establish these diagnoses.
» READ BOOK EXCERPT ONLINE »
Source: Differential Diagnosis in Primary Care, 2007
Epididymitis:
Diagnosis
(Professional Guide to Diseases (Eighth Edition))
Clinical features suggest epididymitis but diagnosis is actually made with the aid of laboratory tests:
❑ urinalysis: increased white blood cell (WBC) count indicates infection
❑ urine culture and sensitivity tests: may identify causative organism
❑ serum WBC count: more than 10,000/µl in infection.
Alert Scrotal ultrasonography may help differentiate acute epididymitis from other conditions, such as testicular torsion, which is a surgical emergency.
Testicular scan (nuclear medicine scan) may be done to rule out torsion. In epididymitis, increased blood flow is also demonstrated.
» READ BOOK EXCERPT ONLINE »
Source: Professional Guide to Diseases (Eighth Edition), 2005
Epididymitis:
Diagnosis
(Handbook of Diseases)
Clinical features suggest epididymitis, but the actual diagnosis is made with the aid of the following laboratory tests:
❑ Urinalysis shows an increased white blood cell (WBC) count, indicating infection.
❑ Urine culture and sensitivity tests may identify the causative organism.
❑ Serum WBC count of more than 10,000/µl indicates infection.
❑ Scrotal ultrasonography may help differentiate acute epididymitis from other conditions such as testicular torsion, which is a surgical emergency.
» READ BOOK EXCERPT ONLINE »
Source: Handbook of Diseases, 2003
TESTICULAR PAIN:
Approach to the Diagnosis
(Differential Diagnosis in Primary Care)
The approach to the diagnosis of testicular pain involves searching for
a mass; if it is present, certain questions must be answered. Does it
transilluminate (hydrocele)? Can one get above the swelling (testicular
mass)? Is it reducible (hernia)? Does supporting the testicle relieve the
pain (torsion)? A search for prostatic hypertrophy or prostatitis should be
made, particularly in older men. Smears of urethral discharge, urinalysis
and urine culture, cystoscopy, and an intravenous pyelogram (IVP) may be
indicated in selected cases. An exploration for torsion or hernia may be the
only way to establish these diagnoses.
» READ BOOK EXCERPT ONLINE »
Source: Differential Diagnosis in Primary Care, 2007
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