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| __NOTOC__
| | #redirect [[scrotal mass]] |
| {{Infobox_Disease |
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| Name = {{PAGENAME}} |
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| Image = Testes lymphoma.jpg|
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| Caption = Testes: Lymphoma. <br> <small> [http://www.peir.net Image courtesy of Professor Peter Anderson DVM PhD and published with permission © PEIR, University of Alabama at Birmingham, Department of Pathology] </small>|
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| }}
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| {{SI}}
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| {{SCC}},[[User:C Michael Gibson |C. Michael Gibson, M.S., M.D.]] [mailto:charlesmichaelgibson@gmail.com]
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| ==Overview==
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| A mass in the scrotum can be in the contents of the scrotum, the wall, or the scrotum itself. All scrotal masses should be evaluated via surgical investigation. Scrotal masses are separated into two categories: Painful and nonpainful masses.
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| [[Torsion]] is painful and may require surgical intervention. Scrotal swelling that does not contain a mass is most likely associated with a different medical condition such as [[heart failure]] or [[edema]].
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| NOTE:ALL INTRATESTICULAR MASSES ARE CONSIDERED CANCER UNLESS PROVEN OTHERWISE.
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| == Causes ==
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| ===Causes in Alphabetical Order<ref>Sailer, Christian, Wasner, Susanne. Differential Diagnosis Pocket. Hermosa Beach, CA: Borm Bruckmeir Publishing LLC, 2002:77 ISBN 1591032016</ref> <ref>Kahan, Scott, Smith, Ellen G. In A Page: Signs and Symptoms. Malden, Massachusetts: Blackwell Publishing, 2004:68 ISBN 140510368X</ref>===
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| ====Painful====
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| *Blunt [[trauma]]
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| *Cavernous lymphangioma torsion
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| *[[Cysticercosis]]
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| *[[Dermoid cyst]] (children)
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| *[[Epididymitis]]
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| *[[Hematocele]]
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| *[[Hydrocele]]
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| *[[Orchitis]]
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| *Scrotal [[abscess]]
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| *[[Spermatocele]] torsion
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| *[[Testicular torsion]]
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| *Testicular appendage torsion
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| ====Non-Painful====
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| *[[Epididymal cyst]]
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| *[[Hydrocele]]
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| *Scrotal hernia
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| *[[Scrotal swelling]]
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| *[[Spermatocele]]
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| *Sperm [[granuloma]]
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| *[[Strangulated hernia]]
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| *[[Testicular Cancer]]
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| *[[Varicocele]]
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| == Diagnosis ==
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| === History ===
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| *Onset & duration of symptoms
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| *[[Trauma]]
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| *Past/[[family history]]
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| *Sexual history
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| ===Symptoms===
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| *[[Fever]]
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| *[[Weight loss]]
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| *[[Pain]]
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| *[[Enlarged lymph nodes]]
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| ===Physical Examination===
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| ==== Testicles ====
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| *Compare the size, tenderness and position
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| *Palpatate [[spermatic cord]]
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| *Transilluminate areas that could potentially contain a mass
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| *Explore cords and canals for hernia, tenderness etc.
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| *Digital [[rectal exam]]
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| ====Epididymitis====
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| In patients with [[epididymitis]], the pain will be relieved upon lifting the [[testicle]] above the [[symphysis pubis]].
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| === Laboratory Findings ===
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| *Labs include:
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| :*[[CBC]]
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| :*urethral gram
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| :*[[urinalysis]]
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| :*urethral culture
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| === Chest X Ray ===
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| *Required if solid mass is found
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| === MRI and CT ===
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| *Abdominal CT if solid mass is found
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| ====MRI Findings====
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| {|
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| ! T2: Adenomatoid tumor !! T2: Adenomatoid tumor !! STIR:Adenomatoid tumor
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| |-
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| | [[Image:Adenomatoid tumor 002.jpg|300px]] || [[Image:Adenomatoid tumor 003.jpg|300px]] || [[Image:Adenomatoid tumor 004.jpg|300px]]
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| |}
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| ----
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| {|
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| ! T1 pre contrast: Adenomatoid tumor !! T1 post GAD: Adenomatoid tumor
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| |-
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| | [[Image:Adenomatoid tumor 005.jpg|300px]] || [[Image:Adenomatoid tumor 001.jpg|300px]]
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| |}
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| ====CT Findings====
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| {|valign="top"
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| !Hydrocele !! Hydrocele
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| |-
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| | [[Image:Hydrocele-001.jpg|300px]] || [[Image:Hydrocele-002.jpg|300px]]
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| |}
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| {|valign="top"
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| ! Varicocele !! Varicocele !! Varicocele
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| |-
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| | [[Image:Varicocele-101.jpg|300px]] || [[Image:Varicocele-102.jpg|300px]] || [[Image:Varicocele-103.jpg|300px]]
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| |}
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| === Echocardiography or Ultrasound ===
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| *Ultrasound should be performed on all patients
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| *Doppler if suspicion of torsion
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| ====Ultrasound====
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| {|
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| ! Epididymal cyst !! Epididymal cyst
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| |-
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| | [[Image:Epididymal cyst 001.jpg|300px]] || [[Image:Epididymal cyst 002.jpg|300px]]
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| |}
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| {|
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| ! Large epididymal cyst !! Large epididymal cyst !! Large epididymal cyst
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| |-
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| | [[Image:Large epididymal cyst 001.jpg|300px]] || [[Image:Large epididymal cyst 002.jpg|300px]] || [[Image:Large epididymal cyst 003.jpg|300px]]
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| |}
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| {|
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| ! Hydrocele !! Hydrocele
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| |-
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| | [[Image:Hydrocele-101.jpg|300px]] || [[Image:Hydrocele-102.jpg|300px]]
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| |}
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| Image:Varicocele-001.jpg|Varicocele
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| Image:Varicocele-002.jpg|Varicocele
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| Image:Varicocele-003.jpg|Varicocele
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| Image:Varicocele-004.jpg|Varicocele
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| </gallery>
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| === Other Diagnostic Studies ===
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| *If solid mass found consider serum [[tumor markers]], [[LDH]], [[electrolytes]], [[BUN]] / [[creatinine]]
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| *Urology consult
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| == Treatment ==
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| ===Torsion===
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| *Considered an emergency
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| *Penetrate [[spermatic cord]] with 10-20mL 1% [[lidocaine]] and gently twist testicles to the left and right.
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| *Relief should be evident immediately upon relief of torsion
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| *Surgery is indicated if unsuccessful
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| === Acute Pharmacotherapies ===
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| ====Epididymitis====
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| *Treat with antibiotics and analgesics
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| ====Orchitis====
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| *Treat with antibiotics and analgesics
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| ==References==
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| {{Reflist|2}}
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| [[Category:Urologic Disease]]
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| [[Category:Signs and symptoms]]
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| [[Category:Emergency medicine]]
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| {{WH}}
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| {{WikiDoc Sources}}
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