Scrotal mass differential diagnosis: Difference between revisions

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==Differential Diagnosis==
==Differential Diagnosis==
The table below summarizes the findings that differentiates scrotal mass according to the clinical features, laboratory findings, imaging features, histological features, and genetic studies.
The table below summarizes the findings that differentiates scrotal mass according to the clinical features, laboratory findings, imaging features, histological features, and genetic studies.
{|
{|
|- style="background: #4479BA; color: #FFFFFF; text-align: center;"
|- style="background: #4479BA; color: #FFFFFF; text-align: center;"
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! rowspan="4" style="background: #4479BA; color: #FFFFFF; text-align: center;" |Associated  
! rowspan="4" style="background: #4479BA; color: #FFFFFF; text-align: center;" |Associated  
|-
|-
| rowspan="11" style="background: #4479BA; color: #FFFFFF; text-align: center;" |Painful
| rowspan="10" style="background: #4479BA; color: #FFFFFF; text-align: center;" |Painful
| colspan="4" rowspan="2" style="background: #4479BA; color: #FFFFFF; text-align: center;" |'''Symptoms'''
| colspan="4" rowspan="2" style="background: #4479BA; color: #FFFFFF; text-align: center;" |'''Symptoms'''
! colspan="5" rowspan="2" style="background: #4479BA; color: #FFFFFF; text-align: center;" |Physical examination
! colspan="5" rowspan="2" style="background: #4479BA; color: #FFFFFF; text-align: center;" |Physical examination
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! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Inguinal Lymphadenopathy
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Inguinal Lymphadenopathy
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Cremasteric Reflex
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Cremasteric Reflex
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Urine Analysis
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Blood/Urine Analysis
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Doppler U/S
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Doppler U/S
|-
|-
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[[Leukocytosis]]
[[Leukocytosis]]
| style="background: #F5F5F5; padding: 5px;" |Enlarged (>17 mm) [[epididymis]] with a hypoechoic, hyperechoic, or [[heterogeneous]] echotexture, increased blood flow
| style="background: #F5F5F5; padding: 5px;" |Enlarged (>17 mm) [[epididymis]] with a hypoechoic, hyperechoic, or [[heterogeneous]] echotexture, increased blood flow
| style="background: #F5F5F5; padding: 5px;" |[[Hydrocele]]
| style="background: #F5F5F5; padding: 5px;" |
* [[Hydrocele]]
* [[Urinary tract infection]]
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
* [[Acute]] infection is characterized by infiltration of [[neutrophils]].
* [[Acute]] infection is characterized by infiltration of [[neutrophils]].
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| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
* [[Ultrasound]] for diagnosis ([[Testicular masses]]<nowiki/>or swollen [[testicles]] with hypoechoic and hypervascular areas)
* [[Ultrasound]] for diagnosis ([[Testicular masses]]<nowiki/>or swollen [[testicles]] with hypoechoic and hypervascular areas)
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |Phen sign +ve
|-
|-
|[[Orchitis]]
|[[Orchitis]]
|Unilateral or bilateral
([[Mumps]])
|Bilateral
|Abrupt  
|Abrupt  
|±
|±
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|
|
* [[Ultrasound]] for diagnosis ([[Testicular masses]]<nowiki/>or swollen [[testicles]] with hypoechoic and hypervascular areas)
* [[Ultrasound]] for diagnosis ([[Testicular masses]]<nowiki/>or swollen [[testicles]] with hypoechoic and hypervascular areas)
|
|Phen sign +ve
|-
|-
| style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Testicular torsion|Testicular Torsion]]<ref name="pmid16724203">{{cite journal |vauthors=Gunther P, Schenk JP, Wunsch R, Holland-Cunz S, Kessler U, Troger J, Waag KL |title=Acute testicular torsion in children: the role of sonography in the diagnostic workup |journal=Eur Radiol |volume=16 |issue=11 |pages=2527–32 |date=November 2006 |pmid=16724203 |doi=10.1007/s00330-006-0287-1 |url=}}</ref>
| style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Testicular torsion|Testicular Torsion]]<ref name="pmid16724203">{{cite journal |vauthors=Gunther P, Schenk JP, Wunsch R, Holland-Cunz S, Kessler U, Troger J, Waag KL |title=Acute testicular torsion in children: the role of sonography in the diagnostic workup |journal=Eur Radiol |volume=16 |issue=11 |pages=2527–32 |date=November 2006 |pmid=16724203 |doi=10.1007/s00330-006-0287-1 |url=}}</ref>
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| style="background: #F5F5F5; padding: 5px;" | +
| style="background: #F5F5F5; padding: 5px;" | +
| style="background: #F5F5F5; padding: 5px;" | +
| style="background: #F5F5F5; padding: 5px;" | +
| style="background: #F5F5F5; padding: 5px;" |Blood in semen
| style="background: #F5F5F5; padding: 5px;" |Blood in semen may be present
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |Absent
| style="background: #F5F5F5; padding: 5px;" | -
| style="background: #F5F5F5; padding: 5px;" | -
| style="background: #F5F5F5; padding: 5px;" |Normal
| style="background: #F5F5F5; padding: 5px;" |Normal
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| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
* [[Doppler ultrasound]]> [[Computed tomography|CT scan]]
* [[Doppler ultrasound]]> [[Computed tomography|CT scan]]
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |Phen sign +ve
|-
| style="background: #DCDCDC; padding: 5px; text-align: center;" |Torsion of testicular appendix
| style="background: #F5F5F5; padding: 5px;" |Unilateral
| style="background: #F5F5F5; padding: 5px;" |Sudden
| style="background: #F5F5F5; padding: 5px;" | -
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" | +
| style="background: #F5F5F5; padding: 5px;" | +
| style="background: #F5F5F5; padding: 5px;" | -
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" | -
| style="background: #F5F5F5; padding: 5px;" |Normal
| style="background: #F5F5F5; padding: 5px;" |Absent or decreased arterial perfusion of the testis
| style="background: #F5F5F5; padding: 5px;" |<nowiki/>
* [[Prematurity]]
* [[Undescended testes]]
* [[Low birth weight]]
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
* [[Doppler ultrasound]]> [[Computed tomography|CT scan]]
| style="background: #F5F5F5; padding: 5px;" |prepubertal period
|-
|-
|[[Hematocele]]
|[[Hematocele]]
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|<nowiki>+</nowiki>
|<nowiki>+</nowiki>
|Blood in semen
|Blood in semen
|Absent
|
|
|
|
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|
|
|
|
|
* Ultrasonography: to check for testicular rupture.
|
|
|-
|-
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|Sudden
|Sudden
|<nowiki>+</nowiki>
|<nowiki>+</nowiki>
| -
| Absent
| +
| +
|<nowiki>+</nowiki>
|<nowiki>+</nowiki>
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!Inguinal Lymphadenopathy
!Inguinal Lymphadenopathy
!Cremasteric Reflex
!Cremasteric Reflex
!Urine Analysis
!Blood/Urine Analysis
!Doppler U/S
!Doppler U/S
!Past Medical History
!Past Medical History
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|
|
|Gradual
|Gradual
|_
| -
|
|Absent
|<nowiki>-</nowiki>
|<nowiki>-</nowiki>
|<nowiki>-</nowiki>
|<nowiki>-</nowiki>
|<nowiki>-</nowiki>
|<nowiki>-</nowiki>
|
|Absent
|
| +
|
|
|
|
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simple fluid collection
simple fluid collection
|
|Transillumination test +ve.
|-
|-
|[[Varicocele]]<ref name="pmid174600033">{{cite journal |vauthors=Yang DM, Kim HC, Lim JW, Jin W, Ryu CW, Kim GY, Cho H |title=Sonographic findings of groin masses |journal=J Ultrasound Med |volume=26 |issue=5 |pages=605–14 |year=2007 |pmid=17460003 |doi= |url=}}</ref>
|[[Varicocele]]<ref name="pmid174600033">{{cite journal |vauthors=Yang DM, Kim HC, Lim JW, Jin W, Ryu CW, Kim GY, Cho H |title=Sonographic findings of groin masses |journal=J Ultrasound Med |volume=26 |issue=5 |pages=605–14 |year=2007 |pmid=17460003 |doi= |url=}}</ref>
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|Gradual
|Gradual
|Local warmth
|Local warmth
|
|Absent
|<nowiki>-</nowiki>
|<nowiki>-</nowiki>
|±
|±
|<nowiki>-</nowiki>
|<nowiki>-</nowiki>
|Absent
|Absent
| +
|
|
|
|
|
|
* [[Renal cancer]]
* [[Nephrectomy]]
* Nut-cracker syndrome
|
|
|
|[[Ultrasonography:]]
|Ultrasonography:


[[tortuous]], [[tubular]], anechoic structures adjacent to the testis corresponding to dilated veins of the [[pampiniform plexus]] with calibers of 2–3 mm during the [[Valsalva maneuver]]
[[tortuous]], [[tubular]], anechoic structures adjacent to the testis corresponding to dilated veins of the [[pampiniform plexus]] with calibers of 2–3 mm during the [[Valsalva maneuver]]
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|<nowiki>-</nowiki>
|<nowiki>-</nowiki>
|Absent
|Absent
|
| +
|
|
|
|
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|
|
|
|
|Ultrasonography:
|[[Ultrasonography]]:


hypoechoic with posterior acoustic enhancement
hypoechoic with posterior acoustic enhancement
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|-
|-
|Scrotal edema
|Scrotal edema
|Bilateral and can extend to perineum
|
|
|
|
|
|
|
|<nowiki>-</nowiki>
|<nowiki>-</nowiki>
|
|<nowiki>-</nowiki>
|<nowiki>-</nowiki>
|<nowiki>-</nowiki>
|
|
|
|
|[[Eosinophilia]]
|
|
|
|
|
|
|
|
|
|Occurs between 4-12 years of age.
|
 
|-
|-
|
|
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|
|
|
|
|Ultrasonography::
|Ultrasonography:


posterior acoustic enhancement, well defined anechoic lesions, larger cysts may contain septations
posterior acoustic enhancement, well defined anechoic lesions, larger cysts may contain septations
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|[[filariasis|Chylocele]] ([[Filariasis]])
|[[filariasis|Chylocele]] ([[Filariasis]])
|
|
|
|Gradually/Rapidly
|
|
|
|

Revision as of 20:42, 23 January 2019

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]Associate Editor(s)-in-Chief: Sujit Routray, M.D. [2]

Overview

Scrotal masses may be differentiated according to clinical features, laboratory findings, imaging features, histological features, and genetic studies from other diseases that cause testicular mass with discomfort, back pain, abdominal discomfort, or abdominal mass. Common differential diagnoses include yolk sac tumor, teratoma, choriocarcinoma, embryonal cell carcinoma, seminoma, and testicular lymphoma (usually non-Hodgkin lymphoma).

Differential Diagnosis

The table below summarizes the findings that differentiates scrotal mass according to the clinical features, laboratory findings, imaging features, histological features, and genetic studies.

Scrotal Swelling Diseases Clinical manifestations Para-clinical findings Gold standard Associated
Painful Symptoms Physical examination
Lab Findings Past Medical History Histopathology
Unilateral /Bilateral swelling Onset Fever Urinary symptoms Tenderness Erythema Discharge Inguinal Lymphadenopathy Cremasteric Reflex Blood/Urine Analysis Doppler U/S
Epididymitis[1] Unilateral Gradual ± Dysuria, frequency, and/or urgency + _ Pyuria Painful local lymphadenopathy +

Leukocytosis

Enlarged (>17 mm) epididymis with a hypoechoic, hyperechoic, or heterogeneous echotexture, increased blood flow Phen sign +ve
Orchitis

(Mumps)

Bilateral Abrupt ± Dysuria + - ± Painful local lymphadenopathy + Leukocytosis Phen sign +ve
Testicular Torsion[2] Unilateral Sudden - + + Blood in semen may be present Absent - Normal Absent or decreased arterial perfusion of the testis Phen sign +ve
Hematocele Unilateral or bilateral Sudden - + + Blood in semen Absent
  • Ultrasonography: to check for testicular rupture.
Incarcerated Hernia[3][4] Unilateral Sudden + Absent + + - Absent
Testicular Abcess -
Brucellosis -
Histoplasma
Gonorrhea
Fournier's gangrene
Scrotal Swelling Diseases Unilateral /Bilateral swelling Onset Fever Urinary symptoms Tenderness Erythema Discharge Inguinal Lymphadenopathy Cremasteric Reflex Blood/Urine Analysis Doppler U/S Past Medical History Histopathology Gold standard Additional findings
Painless Fragile XMacroorchidism Bilateral - +
Testicular Tumors ± +
Henoch-Schonlein purpura - -
Hydrocele[5] Gradual - Absent - - - Absent + Ultrasound:

simple fluid collection

Transillumination test +ve.
Varicocele[6] Unilateral

(Mainly left)

Gradual Local warmth Absent - ± - Absent + Ultrasonography:

tortuous, tubular, anechoic structures adjacent to the testis corresponding to dilated veins of the pampiniform plexus with calibers of 2–3 mm during the Valsalva maneuver

Spermatocele[7] Gradual - - - Absent +
  • Falling snow, resulting from internal echoes moving away from the transducer
 Ultrasonography:

hypoechoic with posterior acoustic enhancement

Inguino-scrotal hernia[8][3] - - Absent
Scrotal edema Bilateral and can extend to perineum - - - Eosinophilia Occurs between 4-12 years of age.
Epididymal cyst[9] ± Ultrasonography:

posterior acoustic enhancement, well defined anechoic lesions, larger cysts may contain septations

Scrotal oedema
Sebaceous cyst
Carcinoma of the scrotum
Chylocele (Filariasis) Gradually/Rapidly
Cystic dysplasia
Srotoliths

References

  1. ↑ Yu KJ, Wang TM, Chen HW, Wang HH (2012). "The dilemma in the diagnosis of acute scrotum: clinical clues for differentiating between testicular torsion and epididymo-orchitis". Chang Gung Med J. 35 (1): 38–45. PMID 22483426.
  2. ↑ Gunther P, Schenk JP, Wunsch R, Holland-Cunz S, Kessler U, Troger J, Waag KL (November 2006). "Acute testicular torsion in children: the role of sonography in the diagnostic workup". Eur Radiol. 16 (11): 2527–32. doi:10.1007/s00330-006-0287-1. PMID 16724203.
  3. ↑ 3.0 3.1 Jenkins JT, O'Dwyer PJ (2008). "Inguinal hernias". BMJ. 336 (7638): 269–72. doi:10.1136/bmj.39450.428275.AD. PMC 2223000. PMID 18244999.
  4. ↑ Berger D (2016). "Evidence-Based Hernia Treatment in Adults". Dtsch Arztebl Int. 113 (9): 150–7, quiz 158. doi:10.3238/arztebl.2016.0150. PMC 4802357. PMID 26987468.
  5. ↑ Yang DM, Kim HC, Lim JW, Jin W, Ryu CW, Kim GY, Cho H (2007). "Sonographic findings of groin masses". J Ultrasound Med. 26 (5): 605–14. PMID 17460003.
  6. ↑ Yang DM, Kim HC, Lim JW, Jin W, Ryu CW, Kim GY, Cho H (2007). "Sonographic findings of groin masses". J Ultrasound Med. 26 (5): 605–14. PMID 17460003.
  7. ↑ Yang DM, Kim HC, Lim JW, Jin W, Ryu CW, Kim GY, Cho H (2007). "Sonographic findings of groin masses". J Ultrasound Med. 26 (5): 605–14. PMID 17460003.
  8. ↑ Berger D (2016). "Evidence-Based Hernia Treatment in Adults". Dtsch Arztebl Int. 113 (9): 150–7, quiz 158. doi:10.3238/arztebl.2016.0150. PMC 4802357. PMID 26987468.
  9. ↑ Yang DM, Kim HC, Lim JW, Jin W, Ryu CW, Kim GY, Cho H (2007). "Sonographic findings of groin masses". J Ultrasound Med. 26 (5): 605–14. PMID 17460003.
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