Scrotal mass differential diagnosis: Difference between revisions

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[[Leukocytosis]]
[[Leukocytosis]]
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| 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]]
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| style="background: #F5F5F5; padding: 5px;" |Blood in semen
| style="background: #F5F5F5; padding: 5px;" |Blood in semen
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| style="background: #F5F5F5; padding: 5px;" |_
| style="background: #F5F5F5; padding: 5px;" | -
| style="background: #F5F5F5; padding: 5px;" |Normal
| style="background: #F5F5F5; padding: 5px;" |Normal
| style="background: #F5F5F5; padding: 5px;" |Absent or decreased arterial perfusion of the testis
| style="background: #F5F5F5; padding: 5px;" |Absent or decreased arterial perfusion of the testis
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| style="background: #F5F5F5; padding: 5px;" |Normal
| style="background: #F5F5F5; padding: 5px;" |Normal
| style="background: #F5F5F5; padding: 5px;" |Absent or decreased arterial perfusion of the testis
| style="background: #F5F5F5; padding: 5px;" |Absent or decreased arterial perfusion of the testis
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!Diseases
!Diseases
!Unilateral /Bilateral swelling
!Unilateral /Bilateral swelling
!Lab 3
!Onset
! colspan="1" rowspan="1" |Fever
! colspan="1" rowspan="1" |Fever
!Urinary symptoms
!Urinary symptoms
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|[[Ultrasound|Ultrasound:]]
 
simple fluid collection
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|[[Varicocele]]
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|Gradual
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|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]]
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|[[Spermatocele]]
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* Falling snow, resulting from internal echoes moving away from the transducer
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hypoechoic with posterior acoustic enhancement
 
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|Ultrasonography::
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posterior acoustic enhancement, well defined anechoic lesions, larger cysts may contain septations
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Revision as of 18:28, 23 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 Urine Analysis Doppler U/S
Epididymitis[1] Unilateral Gradual ± Dysuria, frequency, and/or urgency + _ Pyuria +

Leukocytosis

Enlarged (>17 mm) epididymis with a hypoechoic, hyperechoic, or heterogeneous echotexture, increased blood flow Hydrocele
Orchitis Unilateral or bilateral Abrupt ± ± + - ± + Leukocytosis
Testicular Torsion[2] Unilateral Sudden - + + Blood in semen - Normal Absent or decreased arterial perfusion of the testis
Torsion of testicular appendix Unilateral Sudden - + + - - Normal Absent or decreased arterial perfusion of the testis prepubertal period
Hematocele Unilateral or bilateral Sudden - + + Blood in semen
Incarcerated Hernia[3][4] Unilateral Sudden + - + + -
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 Urine Analysis Doppler U/S Past Medical History Histopathology Gold standard Additional findings
Painless Fragile XMacroorchidism - +
Testicular Tumors ± +
Henoch-Schonlein purpura - -
Hydrocele Gradual _ - - - Ultrasound:

simple fluid collection

Varicocele Gradual Local warmth - ± - 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 Gradual - - -
  • Falling snow, resulting from internal echoes moving away from the transducer
Ultrasonography:

hypoechoic with posterior acoustic enhancement

Inguino-scrotal hernia[5][3] - -
Scrotal edema - -
Epididymal cyst ± Ultrasonography::

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

Scrotal oedema
Sebaceous cyst
Carcinoma of the scrotum
Chylocele (Filariasis)
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. 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.