Scrotal mass differential diagnosis: Difference between revisions

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| style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Hydrocele]]<ref name="pmid174600034">{{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>
| style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Hydrocele]]<ref name="pmid174600034">{{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>
| style="background: #F5F5F5; padding: 5px; text-align: center;"|
| style="background: #F5F5F5; padding: 5px; text-align: center;" |
| style="background: #F5F5F5; padding: 5px; text-align: left;"|Gradual
| style="background: #F5F5F5; padding: 5px; text-align: left;" |Gradual
| style="background: #F5F5F5; padding: 5px; text-align: center;"| -
| style="background: #F5F5F5; padding: 5px; text-align: center;" | -
| style="background: #F5F5F5; padding: 5px; text-align: center;"|Absent
| style="background: #F5F5F5; padding: 5px; text-align: center;" |Absent
| style="background: #F5F5F5; padding: 5px; text-align: center;"|<nowiki>-</nowiki>
| style="background: #F5F5F5; padding: 5px; text-align: center;" |<nowiki>-</nowiki>
| style="background: #F5F5F5; padding: 5px; text-align: center;"|<nowiki>-</nowiki>
| style="background: #F5F5F5; padding: 5px; text-align: center;" |<nowiki>-</nowiki>
| style="background: #F5F5F5; padding: 5px; text-align: center;"|<nowiki>-</nowiki>
| style="background: #F5F5F5; padding: 5px; text-align: center;" |<nowiki>-</nowiki>
| style="background: #F5F5F5; padding: 5px; text-align: left;"|Absent
| style="background: #F5F5F5; padding: 5px; text-align: left;" |Absent
| style="background: #F5F5F5; padding: 5px; text-align: center;"| +
| style="background: #F5F5F5; padding: 5px; text-align: center;" | +
| style="background: #F5F5F5; padding: 5px; text-align: center;"|
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| style="background: #F5F5F5; padding: 5px; text-align: left;"|[[Ultrasound|Ultrasound:]]
| style="background: #F5F5F5; padding: 5px; text-align: left;" |[[Ultrasound|Ultrasound:]]
simple fluid collection
simple fluid collection
| style="background: #F5F5F5; padding: 5px; text-align: left;"|Transillumination test +ve.
| style="background: #F5F5F5; padding: 5px; text-align: left;" |Transillumination test +ve.
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| style="background: #DCDCDC; padding: 5px; text-align: center;" |[[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>
| style="background: #DCDCDC; padding: 5px; text-align: center;" |[[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>
| style="background: #F5F5F5; padding: 5px; text-align: left;"|Unilateral
| style="background: #F5F5F5; padding: 5px; text-align: left;" |Unilateral
(Mainly left)
(Mainly left)
| style="background: #F5F5F5; padding: 5px; text-align: left;"|Gradual
| style="background: #F5F5F5; padding: 5px; text-align: left;" |Gradual
| style="background: #F5F5F5; padding: 5px; text-align: left;"|Local warmth
| style="background: #F5F5F5; padding: 5px; text-align: left;" |Local warmth
| style="background: #F5F5F5; padding: 5px; text-align: left;"|Absent
| style="background: #F5F5F5; padding: 5px; text-align: left;" |Absent
| style="background: #F5F5F5; padding: 5px; text-align: center;"|<nowiki>-</nowiki>
| style="background: #F5F5F5; padding: 5px; text-align: center;" |<nowiki>-</nowiki>
| style="background: #F5F5F5; padding: 5px; text-align: center;"|±
| style="background: #F5F5F5; padding: 5px; text-align: center;" |±
| style="background: #F5F5F5; padding: 5px; text-align: center;"|<nowiki>-</nowiki>
| style="background: #F5F5F5; padding: 5px; text-align: center;" |<nowiki>-</nowiki>
| style="background: #F5F5F5; padding: 5px; text-align: left;"|Absent
| style="background: #F5F5F5; padding: 5px; text-align: left;" |Absent
| style="background: #F5F5F5; padding: 5px; text-align: center;"| +
| style="background: #F5F5F5; padding: 5px; text-align: center;" | +
| style="background: #F5F5F5; padding: 5px; text-align: center;"|
| style="background: #F5F5F5; padding: 5px; text-align: center;" |
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* [[Renal cancer]]
* [[Renal cancer]]
* [[Nephrectomy]]
* [[Nephrectomy]]
* Nut-cracker syndrome
* Nut-cracker syndrome
|style="background: #F5F5F5; padding: 5px; text-align: left;"| style="background: #F5F5F5; padding: 5px; text-align: left;"|
| style="background: #F5F5F5; padding: 5px; text-align: left;" |<nowiki> style="background: #F5F5F5; padding: 5px; text-align: left;"|</nowiki>
|style="background: #F5F5F5; padding: 5px; text-align: left;"|[[Ultrasonography:]]
| style="background: #F5F5F5; padding: 5px; text-align: left;" |[[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]]
|style="background: #F5F5F5; padding: 5px; text-align: left;"|
| style="background: #F5F5F5; padding: 5px; text-align: left;" |
|style="background: #F5F5F5; padding: 5px; text-align: center;"|-
| style="background: #F5F5F5; padding: 5px; text-align: center;" | -
| style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Spermatocele]]<ref name="pmid174600032">{{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>
| style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Spermatocele]]<ref name="pmid174600032">{{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>
|style="background: #F5F5F5; padding: 5px; text-align: left;"|
| style="background: #F5F5F5; padding: 5px; text-align: left;" |
|style="background: #F5F5F5; padding: 5px; text-align: left;"|Gradual
| style="background: #F5F5F5; padding: 5px; text-align: left;" |Gradual
|style="background: #F5F5F5; padding: 5px; text-align: left;"|
| style="background: #F5F5F5; padding: 5px; text-align: left;" |
|style="background: #F5F5F5; padding: 5px; text-align: left;"|
| style="background: #F5F5F5; padding: 5px; text-align: left;" |
|style="background: #F5F5F5; padding: 5px; text-align: left;"|<nowiki>-</nowiki>
| style="background: #F5F5F5; padding: 5px; text-align: left;" |<nowiki>-</nowiki>
|style="background: #F5F5F5; padding: 5px; text-align: left;"|<nowiki>-</nowiki>
| style="background: #F5F5F5; padding: 5px; text-align: left;" |<nowiki>-</nowiki>
|style="background: #F5F5F5; padding: 5px; text-align: left;"|<nowiki>-</nowiki>
| style="background: #F5F5F5; padding: 5px; text-align: left;" |<nowiki>-</nowiki>
|style="background: #F5F5F5; padding: 5px; text-align: left;"|Absent
| style="background: #F5F5F5; padding: 5px; text-align: left;" |Absent
|style="background: #F5F5F5; padding: 5px; text-align: center;"| +
| style="background: #F5F5F5; padding: 5px; text-align: center;" | +
|style="background: #F5F5F5; padding: 5px; text-align: left;"|
| style="background: #F5F5F5; padding: 5px; text-align: left;" |
|style="background: #F5F5F5; padding: 5px; text-align: left;"|
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* Falling snow, resulting from internal echoes moving away from the transducer
* Falling snow, resulting from internal echoes moving away from the transducer
|style="background: #F5F5F5; padding: 5px; text-align: left;"|
| style="background: #F5F5F5; padding: 5px; text-align: left;" |
|style="background: #F5F5F5; padding: 5px; text-align: left;"|
| style="background: #F5F5F5; padding: 5px; text-align: left;" |
|style="background: #F5F5F5; padding: 5px; text-align: left;"|[[Ultrasonography]]:
| style="background: #F5F5F5; padding: 5px; text-align: left;" |[[Ultrasonography]]:
hypoechoic with posterior acoustic enhancement
hypoechoic with posterior acoustic enhancement
|style="background: #F5F5F5; padding: 5px; text-align: left;"|
| style="background: #F5F5F5; padding: 5px; text-align: left;" |
|-
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| style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Inguinal hernia|Inguino-scrotal hernia]]<ref name="pmid269874682">{{cite journal |vauthors=Berger D |title=Evidence-Based Hernia Treatment in Adults |journal=Dtsch Arztebl Int |volume=113 |issue=9 |pages=150–7; quiz 158 |year=2016 |pmid=26987468 |pmc=4802357 |doi=10.3238/arztebl.2016.0150 |url=}}</ref><ref name="pmid18244999" />
| style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Inguinal hernia|Inguino-scrotal hernia]]<ref name="pmid269874682">{{cite journal |vauthors=Berger D |title=Evidence-Based Hernia Treatment in Adults |journal=Dtsch Arztebl Int |volume=113 |issue=9 |pages=150–7; quiz 158 |year=2016 |pmid=26987468 |pmc=4802357 |doi=10.3238/arztebl.2016.0150 |url=}}</ref><ref name="pmid18244999" />
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| style="background: #DCDCDC; padding: 5px; text-align: center;" |Scrotal edema
| style="background: #DCDCDC; padding: 5px; text-align: center;" |Scrotal eodema
|Bilateral and can extend to perineum
|Bilateral and can extend to perineum
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|Occurs between 4-12 years of age.
|Occurs between 4-12 years of age.
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|style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Epididymal cyst]]<ref name="pmid17460003">{{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>
| style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Epididymal cyst]]<ref name="pmid17460003">{{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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|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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| style="background: #DCDCDC; padding: 5px; text-align: center;" |Scrotal oedema
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|style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Congenital cystic dysplasia|Cystic dysplasia]]
| style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Congenital cystic dysplasia|Cystic dysplasia]]
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Revision as of 14:42, 28 January 2019

Scrotal Mass Microchapters

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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 + style="background: #F5F5F5; padding: 5px; text-align: left;"| 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 eodema 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

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.