Scrotal masses: Difference between revisions

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Revision as of 21:38, 5 February 2013

Scrotal masses
Testes: Lymphoma.
Image courtesy of Professor Peter Anderson DVM PhD and published with permission © PEIR, University of Alabama at Birmingham, Department of Pathology

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Steven C. Campbell, M.D., Ph.D.,C. Michael Gibson, M.S., M.D. [1]

Overview

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.

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.

ALL INTRATESTICULAR MASSES ARE CONSIDERED CANCER UNLESS PROVEN OTHERWISE

Causes

Causes in Alphabetical Order[1] [2]

Painful

Non-Painful

Diagnosis

History

Symptoms

Physical Examination

Testicles

  • Compare the size, tenderness and position
  • Palpatate spermatic cord
  • Transilluminate areas that could potentially contain a mass
  • Explore cords and canals for hernia, tenderness etc.
  • Digital rectal exam

Epididymitis

In patients with epididymitis, the pain will be relieved upon lifting the testicle above the symphysis pubis.

Laboratory Findings

  • Labs include:

Chest X Ray

  • Required if solid mass is found

MRI and CT

  • Abdominal CT if solid mass is found

MRI Findings

T2: Adenomatoid tumor T2: Adenomatoid tumor STIR:Adenomatoid tumor

T1 pre contrast: Adenomatoid tumor T1 post GAD: Adenomatoid tumor

CT Findings

Hydrocele Hydrocele
Varicocele Varicocele Varicocele

Echocardiography or Ultrasound

  • Ultrasound should be performed on all patients
  • Doppler if suspicion of torsion

Ultrasound

Epididymal cyst Epididymal cyst
Large epididymal cyst Large epididymal cyst Large epididymal cyst

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Other Diagnostic Studies

Treatment

Torsion

  • Considered an emergency
  • Penetrate spermatic cord with 10-20mL 1% lidocaine and gently twist testicles to the left and right.
  • Relief should be evident immediately upon relief of torsion
  • Surgery is indicated if unsuccessful

Acute Pharmacotherapies

Epididymitis

  • Treat with antibiotics and analgesics

Orchitis

  • Treat with antibiotics and analgesics

References

  1. Sailer, Christian, Wasner, Susanne. Differential Diagnosis Pocket. Hermosa Beach, CA: Borm Bruckmeir Publishing LLC, 2002:77 ISBN 1591032016
  2. Kahan, Scott, Smith, Ellen G. In A Page: Signs and Symptoms. Malden, Massachusetts: Blackwell Publishing, 2004:68 ISBN 140510368X

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