Scrotal Masses
Scrotal masses and swelling can involve the contents of the scrotum, the wall of the scrotum, and the scrotum itself. Ultrasonography should be used liberally in evaluating scrotal masses. All solid masses must be evaluated by surgical exploration. Torsion of the testis should be reduced as quickly as possible; however, surgical intervention will still be needed to prevent future torsion in the affected or contralateral testis. Swelling of the scrotum without a mass is usually associated with a separate medical condition, such as heart failure or anasarca.
Differential Diagnosis
Painful masses
-
Torsion of the spermatic cord
–Testicle rides higher on affected side
–Neonate to early 20s
–Sudden pain in one testicle, followed by
swelling and erythema of scrotum
-
Epididymitis
–Testicle position is normal; tenderness at
top and posterior of testicle
–Childhood to old age
–<35 years: Chlamydia, gonorrhea
–>35 years: Enterobacteriaceae
Orchitis
–Testicle position normal
–Usually with epididymitis due to E. coli,
Klebsiella, Pseudomonas; mumps
-
Strangulated hernia (vascular compromise)
-
Trauma
Nonpainful masses
-
Hernia
-
Varicocele
–A collection of dilated tortuous veins posterior to and above testis
-
Testicular cancer
–Most common at ages 15–35
–Gradual onset, though may only be noticed
incidentally following trauma
-
Spermatocele
–Firm, cystic mass containing sperm above and posterior to testis
-
Hydrocele
–Covers anterior surface of the testicle
–Seen in infants but usually closes before 1
year of age, then reappears in men over 40
-
Scrotal swelling
–Edema from cardiac, hepatic, or renal failure
-
Epididymal cyst
–More common in males with in utero DES exposure
Sperm granuloma
–Usually at the site of a prior vasectomy
Less common etiologies include torsion of the appendices of the testis and epididymis, urinary extravasation, lipoma of spermatic cord, and pyogenic or granulomatous orchitis
Workup and Diagnosis
-
History and physical examination including abdomen, back, genitalia, and digital rectal examination
–Onset/duration of symptoms, evidence of trauma, past medical history (e.g., cryptorchidism, testicular atrophy or dysgenesis), family history (e.g. testicular cancer significantly increases risk), sexual activity, and history of GU instrumentation
–Constitutional: Fever, weight loss, pain, face (e.g., parotid glands are enlarged in mumps), breast (e.g., gynecomastia), penis (e.g., ulcers, plaques, induration, urethral discharge), scrotum, and testicles
–Compare size, position, and tenderness of testicles; transilluminate all masses; palpate spermatic cord and inguinal canals (explore for hernias, hidden testicles, cord tenderness); and digital rectal exam
–Lift testicle up over symphysis pubis: Pain relieved in epididymitis (Prehn's sign); no change with torsion
-
Initial laboratory testing may include CBC, urinalysis, urethral gram stain and culture
-
Ultrasound is indicated in all patients; include Doppler flow study if torsion is suspected
–Intratesticular masses are considered to be cancer until proven otherwise
-
If solid mass is found, consider chest X-ray, CT of abdomen, serum tumor markers (AFP, β-hCG), LDH, electrolytes,
BUN/creatinine, calcium, PT/PTT, and obtain urology
consult and consider hematology-oncology consult
Treatment
- Torsion
–Detorsion maneuver: Infiltrate spermatic cord with 10–20 mL of 1% lidocaine, then twist testes counterclockwise on left or clockwise on right; successful detorsion is indicated by immediate relief
–Urologic referral: Emergent if unsuccessful; for
orchiopexy if successful
- Epididymitis and orchitis: Treat with antibiotics
–<35 years: (presumed to be sexually acquired): Treat with ceftriaxone or fluoroquinolone; plus doxycycline or azithromycin or tetracycline
–>35 years: Trimethoprim-sulfamethoxazole or fluoroquinolone, unless history reveals that infection is sexually acquired
–Analgesics
–Scrotal support
–Hospitalize if septic
- If a mass is found that does not have a clear etiology after appropriate evaluation, consult urology
'>'>
Book Source Details
- Book Title: In a Page: Signs and Symptoms
- Author(s): Scott Kahan, Ellen G. Smith
- Year of Publication: 2004
- Copyright Details: In a Page: Signs and Symptoms, Copyright © 2004 Lippincott Williams & Wilkins.
Other Book Chapters Related to Breast lump
Read excerpts from these other book chapters related to Breast lump:
Medical Books Excerpts
- Breast Mass
- "The 10-Minute Diagnosis Manual: Symptoms and Signs in the Time-Limited Encounter" (2000)
- [ read ]
- Mediastinal Mass
- "The 10-Minute Diagnosis Manual: Symptoms and Signs in the Time-Limited Encounter" (2000)
- [ read ]
- Scrotal Mass
- "The 10-Minute Diagnosis Manual: Symptoms and Signs in the Time-Limited Encounter" (2000)
- [ read ]
- FACE MASS
- "Differential Diagnosis in Primary Care" (2007)
- [ read ]
Copyright Details: In a Page: Signs and Symptoms, Copyright © 2008 Williams & Wilkins.
More About Causes of Breast lump
|
|
More About This Book:
Title: In a Page: Signs and Symptoms
Authors: Scott Kahan, Ellen G. Smith
Publisher: Lippincott Williams & Wilkins
Copyright: 2004
ISBN: 1-4051-0368-X
|
|
» Next page: BREAST MASS OR SWELLING (Differential Diagnosis in Primary Care)
Rate This Website
What do you think about the features of this website?
Take our user survey and have your say:
Website User Survey
Medical Tools & Articles:
Next articles:
Tools & Services:
Medical Articles:
Forums & Message Boards
- Ask or answer a question at the Boards:
