Scrotal mass differential diagnosis: Difference between revisions

Latest revision as of 15:16, 23 October 2019

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1];Associate Editor(s)-in-Chief: Niloofarsadaat Eshaghhosseiny, MD [2] Preeti Singh, M.B.B.S.[3]

Overview

Scrotal masses must be differentiated from other diseases that cause scrotal swelling,scrotal pain,such as testicular tortion ,epididimitis,testicular tumors,inguinal herniation and many other diseases.

Differentiating Scrotal masses from the other Diseases

Scrotal masses must be differentiated from other diseases that cause scrotal swelling,scrotal pain,such as testicular tortion ,epididimitis,testicular tumors,inguinal herniation and many other diseases.

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

	Symptoms				Physical examination					Lab Findings		Past Medical History	Histopathology
Diseases	Clinical manifestations									Para-clinical findings				Gold standard	Associated
	Symptoms				Physical examination					Para-clinical findings
	Unilateral /Bilateral swelling	Onset	Fever	Urinary symptoms	Tender -ness	Erythema	Discharge	Inguinal Lymphadenopathy	Cremasteric Reflex	Blood/Urine Analysis	Doppler U/S	Past Medical History	Histopathology
Painful
Epididymitis^[1]^[2] ^[3]^[4]^[5]^[6]^[7]^[8]	Unilateral	Gradual	±	Dysuria, frequency, and/or urgency	+	-	+ (Pyuria Bacteriuria)	Painful local lymphadenopathy	+	CBC-Leukocytosis Urine culture (pre-pubertal and elderly) NAAT Immunofluorescent antibody testing	Decreased epididymal blood flow	Enlarged (>17 mm) epididymis with a hypoechoic, hyperechoic, or heterogeneous echotexture, increased blood flow	Acute infection is characterized by infiltration of neutrophils. Chronic cases are characterized by granulomatous inflammation.	Ultrasound for diagnosis (Testicular massesor swollen testicles with hypoechoic and hypervascular areas)	Hydrocele Urinary tract infection Gonococcal infection chlamydia infection Phen sign +ve
Orchitis (Mumps)^[9]^[10]^[11]^[12] ^[13]^[8]^[7]^[14]	Bilateral	Abrupt	±	Dysuria	+	-	±	Painful local lymphadenopathy	+	CBC-Leukocytosis raised CRP Immunofluorescent antibody testing Urine analysis and culture - normal	Increased blood flow in affected side.	Mumps, coxsackievirus infection Concurrent epididymitis Congenital abnornmalities	Tubules are infiltration with neutrophiles, lymphocytes and cells resembling histiocytes Microscopic destruction of spermatogenic cells	RT‐PCR Serum immunofluorescence antibody testing.	Phen sign +ve Testicular atrophy Infertility
Testicular Torsion^[15]^[16]^[17]^[18]^[19]^[7]	Unilateral	Sudden	-	Absent	+	+	+ Blood in semen may be present	Absent	-	Normal	Absent or decreased arterial perfusion of the testis	Previous history of testicular torsion Family history of testicular torsion Prematurity Undescended testes Low birth weight	In the first 4 hours: testicular parenchyma shows edema and and desquamation of the germ cells 4-8 hours partial necrosis of germ cells. >24 hrs: necrosis	Doppler ultrasound> CT scan	Phen sign +ve
Hematocele^[20]^[21] ^[22]^[23]^[24]	Unilateral or bilateral	Sudden	-	Absent	+	+	+ Blood in semen	Absent	-	Urinalysis may be the only indication of injury to urinary tract Hematuria.	Scrotal wall thickening and testicular hematoma	Testicular trauma related to: Sports injuries. Direct trauma Motor vehicle accidents Straddle injuries	Increased destruction and fibrosis of the dartos fascia,. Dense inflammatory cells, necrotic areas and destruction of the muscular layer.	Ultrasonography: to check for testicular rupture.	_
Incarcerated Hernia^[25]^[26]	Unilateral	Sudden	+	Absent	+	+	-	Absent	+	Normal	Normal	-	-	Groin ultrasound or CT scan show presence of bowel and omentum.	Valsalva maneuvers performed while palpating the inguinal canal will push a hernia against the examiner's finger.
Brucellosis^[27]^[28]^[29]^[30]	Unilateral or Bilateral	Sudden	±	Dysuria	-	-	±	Painful local lymphadenopathy	+	CBC-Leukocytosis raised CRP Immunofluorescent antibody testing Urine analysis and culture - normal	Increased blood flow in affected side	-	Acute infection is characterized by infiltration of neutrophils. Chronic cases are characterized by granulomatous inflammation.	Culture of the organism from blood.	Antibodies are detected using: Serum agglutination (standard tube agglutination) Enzyme-linked immunosorbent assay Rose Bengal agglutination Coombs test Immunocapture agglutination (Brucellacapt) 2-mercaptoethanol agglutination
Torsion of the appendix testis^[31]^[32]^[33]^[34]	Unilateral or Bilateral	Sudden	-	Absent	+	-	-	Absent	+	Normal	Normal blood flow to the testis with an occasional increase on the affected side	-	In the first 4 hours: testicular appendages shows edema and and desquamation. 4-8 hours partial necrosis of appendix cells. >24 hrs: necrosis	scrotal ultrasound shows the torsed appendage as a lesion of low echogenicity with a central hypoechogenic area.	Scrotal wall mayshow the classical "blue dot" sign, which is due to infarction and necrosis of the appendix testis
Henoch-Schonlein purpura^[35]^[36]^[37]^[38]	Unilateral	Sudden	-	Absent	+	+	-	-	-	Serum IgA levels are elevated Elevated ESR	-	Sore throat 2-3 weeks back	Light microscopy shows leukocytoclastic vasculitis in postcapillary venules with IgA deposition	Biopsy	Palpable purpura Age at onset is less than 20 years Acute abdominal pain
Fournier's gangrene^[39]^[40]^[41]^[42]	Bilateral	Sudden	+	Absent	+	+	-	-	+	Leukocytosis Acidosis Elevated ESR and CRP Blood cultures are positive in majority of patient for streptococcus.	-	-	-	Computed tomography (CT) scan shows most useful finding is presence of gas in soft tissues.	Patient show signs of tense edema outside the involved skin, blisters, bullae, crepitus, and subcutaneous gas.
Diseases	Unilateral /Bilateral swelling	Onset	Fever	Urinary symptoms	Tender<be>-ness	Erythema	Discharge	Inguinal Lymphadenopathy	Cremasteric Reflex	Blood/Urine Analysis	Doppler U/S	Past Medical History	Histopathology	Gold standard	Additional findings
Painless
Fragile X Macroorchidism^[43]^[44]^[45]^[46]	Bilateral	Gradual	-	Absent	-	-	+	Absent	+	Normal	-	-	Increased volume of testis	FMR1 DNA analysis	Long and narrow face with prominent forehead and chin (prognathism) Large ears Intellectual Disability
Testicular Tumors^[47]^[48]^[49]^[50]	Unilateral or bilateral	Gradual	±	Absent	±		+	Present	+	Increased serum beta-hCG or alpha fetoprotien (AFP)	-	-	Seminoma shows findings such as: Large cells with watery cytoplasm Fried egg appearance	Biopsy	Pain in the back or abdomen Ascites Weight loss Gynecomastia Precocious Puberty Infertility
Hydrocele^[51]^[52]^[53]^[54]^[55]	Bilateral	Gradual	-	Absent	-	-	-	Absent	+	-	Normal	-	-	Ultrasound: simple fluid collection	Transillumination test is positive
Varicocele^[56]^[57]^[58]^[59]	Unilateral (Mainly left)	Gradual	Local warmth	Absent	-	±	-	Absent	+	Elevations in unstimulated luteinizing hormone and follicle stimulating hormone levels may be seen in when associated with infertility in adults	Thrombosis of Inferiror vena cava Thrombosis of Right renal vein Abdominal mass	Renal cancer Nephrectomy Nut-cracker syndrome	-	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	Infertility
Spermatocele^[60]^[55]^[61]	Unilateral	Gradual	-	Absent	-	-	-	Absent	+	-	Falling snow, resulting from internal echoes moving away from the transducer	Epididymitis Trauma	Epididymal scarring is seen	Ultrasonography: hypoechoic with posterior acoustic enhancement	Transillumination test is positive
Scrotal edema^[62]^[63]	Bilateral and can extend to perineum	Gradual	-	Absent	-	-	-	Absent	+	Eosinophilia Hypoalbuminemia Hyperlipidemia. Proteinurea	Deep Vein Thrombosis	Nephrotic Syndrome Hepatic Cirrhosis Insect Bite	-	Kidney or Liver biopsy	Occurs between 4-12 years of age.
Sebaceous cyst^[64]^[65]^[66]	Unilateral	Gradual	-	Absent	-	-	-	Absent	+	-	Normal	-	Fibrous tissues and fluids A fatty,(keratinous), substance that resembles cottage cheese,. A viscous, serosanguinous fluid (containing purulent and bloody material).	Histological examination	Freely movable on palpation.
Carcinoma of the scrotum^[67]^[68]^[69]	-	Gradual	-	Absent	-	-	-	Absent	+	-	Normal	-	keratinocytic dysplasia involving the full thickness of the epidermis without infiltration of atypical cells into the dermis. The keratinocytes are pleomorphic with hyperchromatic nuclei Numerous mitoses are present.	Biopsy	Scaly patch or plaque is seen over the testis.
Chylocele (Filariasis)^[70]^[71]^[72]	Unilateral or Bilateral	Gradually Rapidly	+	Absent	-	-	-	Absent	+	Circulating filarial antigen (CFA) assays are positve	Lymphatics containing worms can be differentiated from the blood vessels by irregular movement	-	-	CFA assay	Ultrasound demonstrates living worms which has been described as "filarial dance" sign.
Scrotoliths^[73]^[74]^[75]	Unilateral	Gradual	-	Absent	-	-	-	Absent	+	-	Normal	Trauma Torsion of appendix	-	Ultrasound	Ultrasound shows mobile hyperechoic extratesticular focus in the potential tunica space.

References

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↑ Polk P, McCutchen WT, Phillips JG, Biggs PJ (September 1996). "Polypoid scrotal calcinosis: an uncommon variant of scrotal calcinosis". South. Med. J. 89 (9): 896–7. PMID 8790314.

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@@ Line 1: / Line 1: @@
 __NOTOC__
-{{Scrotal mass}}
+[[Image:Home_logo1.png|right|250px|link=https://www.wikidoc.org/index.php/Scrotal_mass]]
-{{CMG}}{{AE}}{{SR}}
+{{CMG}};{{AE}}{{NE}}{{Preeti}}
 ==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 [[lymphoma|testicular lymphoma]] (usually [[non-Hodgkin lymphoma]]).
+Scrotal masses must be differentiated from other diseases that cause scrotal swelling,scrotal pain,such as testicular tortion ,epididimitis,testicular tumors,inguinal herniation and many other diseases.
-==Differential Diagnosis==
+==Differentiating Scrotal masses from the other Diseases==
-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 mass|Scrotal masses]] must be differentiated from other diseases that cause scrotal swelling,scrotal pain,such as [[Testicular cancer|testicular tortion]] ,[[Epidemic abscess|epididimitis,]]<nowiki/>testicular tumors,[[Inguinal canal|inguinal herniation]] and many other diseases.
+*The table below summarizes the findings that differentiates [[Scrotal mass (patient information)|scrotal mass]] according to the clinical features, laboratory findings, imaging features, [[Histological section|histological features]], and [[genetic]] studies.
 {|
 |- style="background: #4479BA; color: #FFFFFF; text-align: center;"
-!Scrotal Swelling
 ! rowspan="4" style="background: #4479BA; color: #FFFFFF; text-align: center;" |Diseases
 | colspan="9" rowspan="1" style="background: #4479BA; color: #FFFFFF; text-align: center;" |'''Clinical manifestations'''
@@ Line 18: / Line 19: @@
 ! rowspan="4" style="background: #4479BA; color: #FFFFFF; text-align: center;" |Associated
 |-
-| 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="5" rowspan="2" style="background: #4479BA; color: #FFFFFF; text-align: center;" |Physical examination
@@ Line 30: / Line 30: @@
 ! colspan="1" rowspan="1" style="background: #4479BA; color: #FFFFFF; text-align: center;" |Fever
 ! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Urinary symptoms
-! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Tenderness
+! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Tender<br>-ness
 ! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Erythema
 ! colspan="1" rowspan="1" style="background: #4479BA; color: #FFFFFF; text-align: center;" |Discharge
@@ Line 38: / Line 38: @@
 ! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Doppler U/S
 |-
-| style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Epididymoorchitis|Epididymitis]]<ref name="pmid22483426">{{cite journal |vauthors=Yu KJ, Wang TM, Chen HW, Wang HH |title=The dilemma in the diagnosis of acute scrotum: clinical clues for differentiating between testicular torsion and epididymo-orchitis |journal=Chang Gung Med J |volume=35 |issue=1 |pages=38–45 |date=2012 |pmid=22483426 |doi= |url=}}</ref>
+! colspan="16" style="background: #7d7d7d; color: #FFFFFF; text-align: center;" |Painful
-| style="background: #F5F5F5; padding: 5px;" |Unilateral
+|-
+| style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Epididymoorchitis|Epididymitis]]<ref name="pmid22483426">{{cite journal |vauthors=Yu KJ, Wang TM, Chen HW, Wang HH |title=The dilemma in the diagnosis of acute scrotum: clinical clues for differentiating between testicular torsion and epididymo-orchitis |journal=Chang Gung Med J |volume=35 |issue=1 |pages=38–45 |date=2012 |pmid=22483426 |doi= |url=}}</ref><ref name="pmid15949072">{{cite journal |vauthors=Manavi K, Turner K, Scott GR, Stewart LH |title=Audit on the management of epididymo-orchitis by the Department of Urology in Edinburgh |journal=Int J STD AIDS |volume=16 |issue=5 |pages=386–7 |date=May 2005 |pmid=15949072 |doi=10.1258/0956462053888853 |url=}}</ref><br><ref name="pmid29668706">{{cite journal |vauthors=Lee YS, Kim SW, Han SW |title=Different managements for prepubertal epididymitis based on a preexisting genitourinary anomaly diagnosis |journal=PLoS ONE |volume=13 |issue=4 |pages=e0194761 |date=2018 |pmid=29668706 |pmc=5905873 |doi=10.1371/journal.pone.0194761 |url=}}</ref><ref name="pmid2161009">{{cite journal |vauthors=Ralls PW, Jensen MC, Lee KP, Mayekawa DS, Johnson MB, Halls JM |title=Color Doppler sonography in acute epididymitis and orchitis |journal=J Clin Ultrasound |volume=18 |issue=5 |pages=383–6 |date=June 1990 |pmid=2161009 |doi= |url=}}</ref><ref name="pmid26112484">{{cite journal |vauthors=Michel V, Pilatz A, Hedger MP, Meinhardt A |title=Epididymitis: revelations at the convergence of clinical and basic sciences |journal=Asian J. Androl. |volume=17 |issue=5 |pages=756–63 |date=2015 |pmid=26112484 |pmc=4577585 |doi=10.4103/1008-682X.155770 |url=}}</ref><ref name="pmid19002691">{{cite journal |vauthors=Tracy CR, Costabile RA |title=The evaluation and treatment of acute epididymitis in a large university based population: are CDC guidelines being followed? |journal=World J Urol |volume=27 |issue=2 |pages=259–63 |date=April 2009 |pmid=19002691 |doi=10.1007/s00345-008-0338-0 |url=}}</ref><ref name="pmid16730939">{{cite journal |vauthors=Pepe P, Panella P, Pennisi M, Aragona F |title=Does color Doppler sonography improve the clinical assessment of patients with acute scrotum? |journal=Eur J Radiol |volume=60 |issue=1 |pages=120–4 |date=October 2006 |pmid=16730939 |doi=10.1016/j.ejrad.2006.04.016 |url=}}</ref><ref name="pmid18336454">{{cite journal |vauthors=Ludwig M |title=Diagnosis and therapy of acute prostatitis, epididymitis and orchitis |journal=Andrologia |volume=40 |issue=2 |pages=76–80 |date=April 2008 |pmid=18336454 |doi=10.1111/j.1439-0272.2007.00823.x |url=}}</ref>
+| style="background: #F5F5F5; padding: 5px;" |Unilateral
 | style="background: #F5F5F5; padding: 5px;" |Gradual
 | style="background: #F5F5F5; padding: 5px; text-align: center;" |±
@@ Line 45: / Line 47: @@
 | style="background: #F5F5F5; padding: 5px; text-align: center;" | +
 | style="background: #F5F5F5; padding: 5px; text-align: center;" | -
-| style="background: #F5F5F5; padding: 5px;" |Pyuria
+| style="background: #F5F5F5; padding: 5px;" | +
+(Pyuria
+Bacteriuria)
 | style="background: #F5F5F5; padding: 5px;" |Painful local lymphadenopathy
 | style="background: #F5F5F5; padding: 5px; text-align: center;" | +
 | style="background: #F5F5F5; padding: 5px;" |
-| style="background: #F5F5F5; padding: 5px;" |[[Leukocytosis]]
+* CBC-[[Leukocytosis]]
-| style="background: #F5F5F5; padding: 5px;" |Enlarged (>17 mm) [[epididymis]] with a hypoechoic, hyperechoic, or [[heterogeneous]] echotexture, increased blood flow
+* Urine culture (pre-pubertal and elderly)
+* NAAT
+* Immunofluorescent antibody testing
+| style="background: #F5F5F5; padding: 5px;" |
+* Decreased epididymal 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;" |
 * [[Acute]] infection is characterized by infiltration of [[neutrophils]].
@@ Line 57: / Line 67: @@
 * [[Ultrasound]] for diagnosis ([[Testicular masses]]<nowiki/>or swollen [[testicles]] with hypoechoic and hypervascular areas)
 | style="background: #F5F5F5; padding: 5px;" |
-** [[Hydrocele]]
+* [[Hydrocele]]
-** [[Urinary tract infection]]
+* [[Urinary tract infection]]
-** Gonococcal infection
+* Gonococcal infection
-** chlamydia infection
+* chlamydia infection
-** Phen sign +ve
+* Phen sign +ve
-| style="background: #F5F5F5; padding: 5px;" |
 |-
 | style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Orchitis]]
-([[Mumps]])
+[[Orchitis|(]][[Mumps]])<ref name="pmid20070300">{{cite journal |vauthors=Davis NF, McGuire BB, Mahon JA, Smyth AE, O'Malley KJ, Fitzpatrick JM |title=The increasing incidence of mumps orchitis: a comprehensive review |journal=BJU Int. |volume=105 |issue=8 |pages=1060–5 |date=April 2010 |pmid=20070300 |doi=10.1111/j.1464-410X.2009.09148.x |url=}}</ref><ref name="pmid18873054">{{cite journal |vauthors=CHARNY CW, MERANZE DR |title=Pathology of mumps orchitis |journal=J. Urol. |volume=60 |issue=1 |pages=140–6 |date=July 1948 |pmid=18873054 |doi= |url=}}</ref><ref name="pmid4580293">{{cite journal |vauthors=Bjorvatn B |title=Mumps virus recovered from testicles by fine-needle aspiration biopsy in cases of mumps orchitis |journal=Scand. J. Infect. Dis. |volume=5 |issue=1 |pages=3–5 |date=1973 |pmid=4580293 |doi= |url=}}</ref><ref name="pmid609284">{{cite journal |vauthors=Beard CM, Benson RC, Kelalis PP, Elveback LR, Kurland LT |title=The incidence and outcome of mumps orchitis in Rochester, Minnesota, 1935 to 1974 |journal=Mayo Clin. Proc. |volume=52 |issue=1 |pages=3–7 |date=January 1977 |pmid=609284 |doi= |url=}}</ref><br><ref name="pmid19970951">{{cite journal |vauthors=Gall EA |title=The Histopathology of Acute Mumps Orchitis |journal=Am. J. Pathol. |volume=23 |issue=4 |pages=637–51 |date=July 1947 |pmid=19970951 |pmc=1934294 |doi= |url=}}</ref><ref name="pmid18336454">{{cite journal |vauthors=Ludwig M |title=Diagnosis and therapy of acute prostatitis, epididymitis and orchitis |journal=Andrologia |volume=40 |issue=2 |pages=76–80 |date=April 2008 |pmid=18336454 |doi=10.1111/j.1439-0272.2007.00823.x |url=}}</ref><ref name="pmid16730939">{{cite journal |vauthors=Pepe P, Panella P, Pennisi M, Aragona F |title=Does color Doppler sonography improve the clinical assessment of patients with acute scrotum? |journal=Eur J Radiol |volume=60 |issue=1 |pages=120–4 |date=October 2006 |pmid=16730939 |doi=10.1016/j.ejrad.2006.04.016 |url=}}</ref><ref name="pmid10823460">{{cite journal |vauthors=Başekim CC, Kizilkaya E, Pekkafali Z, Baykal KV, Karsli AF |title=Mumps epididymo-orchitis: sonography and color Doppler sonographic findings |journal=Abdom Imaging |volume=25 |issue=3 |pages=322–5 |date=2000 |pmid=10823460 |doi= |url=}}</ref>
 | style="background: #F5F5F5; padding: 5px;" |Bilateral
 | style="background: #F5F5F5; padding: 5px;" |Abrupt
@@ Line 72: / Line 81: @@
 | 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;" | ±
 | style="background: #F5F5F5; padding: 5px;" |Painful local lymphadenopathy
 | style="background: #F5F5F5; padding: 5px; text-align: center;" | +
-| style="background: #F5F5F5; padding: 5px; text-align: center;" |[[Leukocytosis]]
+| style="background: #F5F5F5; padding: 5px; text-align: center;" |
+* CBC-[[Leukocytosis]]
+* raised CRP
+* Immunofluorescent antibody testing
+* Urine analysis and culture - normal
 | style="background: #F5F5F5; padding: 5px;" |
+* Increased blood flow in affected side.
 | style="background: #F5F5F5; padding: 5px;" |
 * [[Mumps]], [[Coxsackie virus|coxsackie]]<nowiki/>virus infection
@@ Line 82: / Line 96: @@
 * [[Congenital disorder|Congenital abnornmalities]]
 | style="background: #F5F5F5; padding: 5px;" |
+* Tubules are infiltration with neutrophiles, lymphocytes and cells resembling histiocytes
+* Microscopic destruction of  spermatogenic cells
+| style="background: #F5F5F5; padding: 5px;" |
+* RT‐PCR
+* Serum immunofluorescence antibody<nowiki/> testing.
 | style="background: #F5F5F5; padding: 5px;" |
-* [[Ultrasound]] for diagnosis ([[Testicular masses]]<nowiki/>or swollen [[testicles]] with hypoechoic and hypervascular areas)
+* Phen sign +ve
-| style="background: #F5F5F5; padding: 5px;" |Phen sign +ve
+* Testicular atrophy
+* Infertility
 |-
-| 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="pmid29240370">{{cite journal |vauthors=Hazeltine M, Panza A, Ellsworth P |title=Testicular Torsion: Current Evaluation and Management |journal=Urol Nurs |volume=37 |issue=2 |pages=61–71, 93 |date=2017 |pmid=29240370 |doi= |url=}}</ref><ref name="pmid28714632">{{cite journal |vauthors=Estremadoyro V, Meyrat BJ, Birraux J, Vidal I, Sanchez O |title=[Diagnosis and management of testicular torsion in children] |language=French |journal=Rev Med Suisse |volume=13 |issue=550 |pages=406–410 |date=February 2017 |pmid=28714632 |doi= |url=}}</ref><ref name="pmid24364548">{{cite journal |vauthors=Sharp VJ, Kieran K, Arlen AM |title=Testicular torsion: diagnosis, evaluation, and management |journal=Am Fam Physician |volume=88 |issue=12 |pages=835–40 |date=December 2013 |pmid=24364548 |doi= |url=}}</ref><ref name="pmid3842075">{{cite journal |vauthors=Mikuz G |title=Testicular torsion: simple grading for histological evaluation of tissue damage |journal=Appl Pathol |volume=3 |issue=3 |pages=134–9 |date=1985 |pmid=3842075 |doi= |url=}}</ref><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><ref name="pmid16730939">{{cite journal |vauthors=Pepe P, Panella P, Pennisi M, Aragona F |title=Does color Doppler sonography improve the clinical assessment of patients with acute scrotum? |journal=Eur J Radiol |volume=60 |issue=1 |pages=120–4 |date=October 2006 |pmid=16730939 |doi=10.1016/j.ejrad.2006.04.016 |url=}}</ref>
 | style="background: #F5F5F5; padding: 5px;" |Unilateral
 | style="background: #F5F5F5; padding: 5px;" |Sudden
 | style="background: #F5F5F5; padding: 5px; text-align: center;" | -
-| style="background: #F5F5F5; padding: 5px;" |
+| style="background: #F5F5F5; padding: 5px;" |Absent
 | style="background: #F5F5F5; padding: 5px; text-align: center;" | +
 | style="background: #F5F5F5; padding: 5px; text-align: center;" | +
-| style="background: #F5F5F5; padding: 5px;" |Blood in semen may be present
+| style="background: #F5F5F5; padding: 5px;" | +
+Blood in semen may be present
 | style="background: #F5F5F5; padding: 5px;" |Absent
 | style="background: #F5F5F5; padding: 5px; text-align: center;" | -
-| style="background: #F5F5F5; padding: 5px;" |Normal
+| style="background: #F5F5F5; padding: 5px;" |
-| style="background: #F5F5F5; padding: 5px;" |Absent or decreased arterial perfusion of the testis
+* Normal
+| style="background: #F5F5F5; padding: 5px;" |
+* Absent or decreased arterial perfusion of the testis
 | style="background: #F5F5F5; padding: 5px;" |
 * Previous history of [[testicular torsion]]
@@ Line 105: / Line 128: @@
 * [[Low birth weight]]
 | style="background: #F5F5F5; padding: 5px;" |
+* In the first 4 hours: testicular parenchyma shows edema and and desquamation of the germ cells
+* 4-8 hours partial necrosis of germ cells.
+* >24 hrs: necrosis
 | style="background: #F5F5F5; padding: 5px;" |
 * [[Doppler ultrasound]]> [[Computed tomography|CT scan]]
-| style="background: #F5F5F5; padding: 5px;" |Phen sign +ve
+| style="background: #F5F5F5; padding: 5px;" |
+* Phen sign +ve
 |-
-| style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Hematocele]]
+| style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Hematocele]]<ref name="pmid25667770">{{cite journal |vauthors=Bowen DK, Gonzalez CM |title=Intratesticular hematoma after blunt scrotal trauma: a case series and algorithm-based approach to management |journal=Cent European J Urol |volume=67 |issue=4 |pages=427–9 |date=2014 |pmid=25667770 |pmc=4310892 |doi=10.5173/ceju.2014.04.art24 |url=}}</ref><ref name="pmid28609265">{{cite journal |vauthors=Askari R, Khouzam RN, Dishmon DA |title=Image Diagnosis: Rapidly Enlarging Scrotal Hematoma: A Complication of Femoral Access? |journal=Perm J |volume=21 |issue= |pages= |date=2017 |pmid=28609265 |pmc=5469436 |doi=10.7812/TPP/16-111 |url=}}</ref><br><ref name="pmid2048502">{{cite journal |vauthors=Mizutani Y, Miyakawa M |title=[A case of idiopathic chronic scrotal hematocele] |language=Japanese |journal=Hinyokika Kiyo |volume=37 |issue=2 |pages=199–201 |date=February 1991 |pmid=2048502 |doi= |url=}}</ref><ref name="pmid2681835">{{cite journal |vauthors=Kratzik C, Hainz A, Kuber W, Donner G, Lunglmayr G, Frick J, Schmoller HJ |title=Has ultrasound influenced the therapy concept of blunt scrotal trauma? |journal=J. Urol. |volume=142 |issue=5 |pages=1243–6 |date=November 1989 |pmid=2681835 |doi= |url=}}</ref><ref name="pmid23833421">{{cite journal |vauthors=Rao MS, Arjun K |title=Sonography of scrotal trauma |journal=Indian J Radiol Imaging |volume=22 |issue=4 |pages=293–7 |date=October 2012 |pmid=23833421 |pmc=3698892 |doi=10.4103/0971-3026.111482 |url=}}</ref>
 | style="background: #F5F5F5; padding: 5px; text-align: left;" |Unilateral or bilateral
 | style="background: #F5F5F5; padding: 5px; text-align: center;" |Sudden
 | 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;" |<nowiki>+</nowiki>
 | style="background: #F5F5F5; padding: 5px; text-align: center;" |<nowiki>+</nowiki>
-| style="background: #F5F5F5; padding: 5px; " |Blood in semen
+| style="background: #F5F5F5; padding: 5px; " | +
+Blood in semen
 | style="background: #F5F5F5; padding: 5px; " |Absent
+| style="background: #F5F5F5; padding: 5px; text-align: center;" |-
 | style="background: #F5F5F5; padding: 5px; text-align: center;" |
+* Urinalysis  may be the only indication of injury to urinary tract
+* [[Hematuria]].
+| style="background: #F5F5F5; padding: 5px; text-align: center;" |Scrotal wall thickening and testicular hematoma
+| style="background: #F5F5F5; padding: 5px; text-align: center;" |Testicular trauma related to:
+* Sports injuries.
+* Direct [[trauma]]
+* Motor vehicle accidents
+* [[Straddle injury|Straddle injuries]]
 | style="background: #F5F5F5; padding: 5px; text-align: center;" |
-| style="background: #F5F5F5; padding: 5px; text-align: center;" |
+* Increased destruction and fibrosis of the dartos fascia,.
-| style="background: #F5F5F5; padding: 5px; text-align: center;" |
+* Dense inflammatory cells, necrotic areas and destruction of the muscular layer.
-| style="background: #F5F5F5; padding: 5px; text-align: center;" |
 | style="background: #F5F5F5; padding: 5px; text-align: left;" |
 * Ultrasonography: to check for testicular rupture.
-| style="background: #F5F5F5; padding: 5px; text-align: center;" |
+| style="background: #F5F5F5; padding: 5px; text-align: center;" |_
 |-
 | style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Inguinal hernia|Incarcerated Hernia]]<ref name="pmid18244999">{{cite journal |vauthors=Jenkins JT, O'Dwyer PJ |title=Inguinal hernias |journal=BMJ |volume=336 |issue=7638 |pages=269–72 |year=2008 |pmid=18244999 |pmc=2223000 |doi=10.1136/bmj.39450.428275.AD |url=}}</ref><ref name="pmid26987468">{{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>
@@ Line 136: / Line 172: @@
 | style="background: #F5F5F5; padding: 5px; text-align: center;" | -
 | style="background: #F5F5F5; padding: 5px; text-align: left;" |Absent
+| style="background: #F5F5F5; padding: 5px; text-align: left;" | +
 | style="background: #F5F5F5; padding: 5px; text-align: left;" |
+* Normal
 | style="background: #F5F5F5; padding: 5px; text-align: left;" |
+* Normal
+| style="background: #F5F5F5; padding: 5px; text-align: left;" | -
+| style="background: #F5F5F5; padding: 5px; text-align: left;" | -
 | style="background: #F5F5F5; padding: 5px; text-align: left;" |
+* Groin ultrasound or CT scan show presence of bowel and omentum.
 | style="background: #F5F5F5; padding: 5px; text-align: left;" |
+* Valsalva maneuvers performed while palpating the inguinal canal will push a hernia against the examiner's finger.
+|-
+| style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Brucellosis]]<ref name="pmid27331193">{{cite journal |vauthors=Kaya F, Kocyigit A, Kaya C, Turkcuer I, Serinken M, Karabulut N |title=Brucellar Testicular Abscess Presenting as a Testicular Mass: Can Color Doppler Sonography be used in Differentiation? |journal=Turk J Emerg Med |volume=15 |issue=1 |pages=43–6 |date=March 2015 |pmid=27331193 |pmc=4909939 |doi=10.5505/1304.7361.2014.82698 |url=}}</ref><ref name="pmid11698991">{{cite journal |vauthors=Navarro-Martínez A, Solera J, Corredoira J, Beato JL, Martínez-Alfaro E, Atiénzar M, Ariza J |title=Epididymoorchitis due to Brucella mellitensis: a retrospective study of 59 patients |journal=Clin. Infect. Dis. |volume=33 |issue=12 |pages=2017–22 |date=December 2001 |pmid=11698991 |doi=10.1086/324489 |url=}}</ref><ref name="pmid17141451">{{cite journal |vauthors=Colmenero JD, Muñoz-Roca NL, Bermudez P, Plata A, Villalobos A, Reguera JM |title=Clinical findings, diagnostic approach, and outcome of Brucella melitensis epididymo-orchitis |journal=Diagn. Microbiol. Infect. Dis. |volume=57 |issue=4 |pages=367–72 |date=April 2007 |pmid=17141451 |doi=10.1016/j.diagmicrobio.2006.09.008 |url=}}</ref><ref name="pmid2313817">{{cite journal |vauthors=Reisman EM, Colquitt LA, Childers J, Preminger GM |title=Brucella orchitis: a rare cause of testicular enlargement |journal=J. Urol. |volume=143 |issue=4 |pages=821–2 |date=April 1990 |pmid=2313817 |doi= |url=}}</ref>
+| style="background: #F5F5F5; padding: 5px; text-align: center;" |Unilateral or Bilateral
+| style="background: #F5F5F5; padding: 5px; text-align: center;" |Sudden
+| style="background: #F5F5F5; padding: 5px; text-align: center;" |±
+| style="background: #F5F5F5; padding: 5px; text-align: center;" |Dysuria
+| 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: left;" |Painful local lymphadenopathy
+| style="background: #F5F5F5; padding: 5px; text-align: center;" |<nowiki>+</nowiki>
 | style="background: #F5F5F5; padding: 5px; text-align: left;" |
+* CBC-[[Leukocytosis]]
+* raised CRP
+* Immunofluorescent antibody testing
+* Urine analysis and culture - normal
 | style="background: #F5F5F5; padding: 5px; text-align: left;" |
+* Increased blood flow in affected side
+| style="background: #F5F5F5; padding: 5px; text-align: center;" |<nowiki>-</nowiki>
 | style="background: #F5F5F5; padding: 5px; text-align: left;" |
-| style="background: #F5F5F5; padding: 5px; text-align: center;"|
+* [[Acute]] infection is characterized by infiltration of [[neutrophils]].
-| -
+* [[Chronic]] cases are characterized by [[granulomatous]] [[inflammation]].
-| style="background: #DCDCDC; padding: 5px; text-align: center;" |Testicular Abcess
 | style="background: #F5F5F5; padding: 5px; text-align: left;" |
+* Culture of the organism from blood.
+| style="background: #F5F5F5; padding: 5px; text-align: left;" |Antibodies are detected using:
+* Serum agglutination (standard tube agglutination)
+* Enzyme-linked immunosorbent assay
+* Rose Bengal agglutination
+* Coombs test
+* Immunocapture agglutination (Brucellacapt)
+* 2-mercaptoethanol agglutination
+|-
+| style="background: #DCDCDC; padding: 5px; text-align: center;" |Torsion of the appendix testis<ref name="pmid16569689">{{cite journal |vauthors=Rakha E, Puls F, Saidul I, Furness P |title=Torsion of the testicular appendix: importance of associated acute inflammation |journal=J. Clin. Pathol. |volume=59 |issue=8 |pages=831–4 |date=August 2006 |pmid=16569689 |pmc=1860437 |doi=10.1136/jcp.2005.034603 |url=}}</ref><ref name="pmid9651416">{{cite journal |vauthors=Kadish HA, Bolte RG |title=A retrospective review of pediatric patients with epididymitis, testicular torsion, and torsion of testicular appendages |journal=Pediatrics |volume=102 |issue=1 Pt 1 |pages=73–6 |date=July 1998 |pmid=9651416 |doi= |url=}}</ref><ref name="pmid7967303">{{cite journal |vauthors=Okui N, Tomita K, Kimura A, Uekane K, Kawamura T, Teshima S |title=[Heterochronic occurrence of bilateral torsion of appendix testis a case report] |language=Japanese |journal=Nippon Hinyokika Gakkai Zasshi |volume=85 |issue=9 |pages=1395–8 |date=September 1994 |pmid=7967303 |doi= |url=}}</ref><ref name="pmid25704247">{{cite journal |vauthors=Lev M, Ramon J, Mor Y, Jacobson JM, Soudack M |title=Sonographic appearances of torsion of the appendix testis and appendix epididymis in children |journal=J Clin Ultrasound |volume=43 |issue=8 |pages=485–9 |date=October 2015 |pmid=25704247 |doi=10.1002/jcu.22265 |url=}}</ref>
+| style="background: #F5F5F5; padding: 5px; text-align: center;" |Unilateral or Bilateral
+| style="background: #F5F5F5; padding: 5px; text-align: center;" |Sudden
+| 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;" | +
+| 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;" | +
+| style="background: #F5F5F5; padding: 5px; text-align: center;" |
+* Normal
 | style="background: #F5F5F5; padding: 5px; text-align: left;" |
+* Normal blood flow to the testis with an occasional increase on the affected side
+| style="background: #F5F5F5; padding: 5px; text-align: center;" | -
 | style="background: #F5F5F5; padding: 5px; text-align: left;" |
+* In the first 4 hours: testicular appendages shows edema and and desquamation.
+* 4-8 hours partial necrosis of appendix cells.
+* >24 hrs: necrosis
 | style="background: #F5F5F5; padding: 5px; text-align: left;" |
-| style="background: #F5F5F5; padding: 5px; text-align: center;" |<nowiki>-</nowiki>
+* scrotal ultrasound shows the torsed appendage as a lesion of low echogenicity with a central hypoechogenic area.
 | style="background: #F5F5F5; padding: 5px; text-align: left;" |
+* Scrotal wall mayshow the classical "blue dot" sign, which is due to infarction and necrosis of the appendix testis
+|-
+| style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Henoch-Schönlein purpura|Henoch-Schonlein purpura]]<ref name="pmid10934812">{{cite journal |vauthors=Choong CS, Liew KL, Liu PN, Kuo TU, Su CM |title=Acute scrotum in Henoch-Schönlein purpura |journal=Zhonghua Yi Xue Za Zhi (Taipei) |volume=63 |issue=7 |pages=577–80 |date=July 2000 |pmid=10934812 |doi= |url=}}</ref><ref name="pmid27169017">{{cite journal |vauthors=Modi S, Mohan M, Jennings A |title=Acute Scrotal Swelling in Henoch-Schonlein Purpura: Case Report and Review of the Literature |journal=Urol Case Rep |volume=6 |issue= |pages=9–11 |date=May 2016 |pmid=27169017 |pmc=4855902 |doi=10.1016/j.eucr.2016.01.004 |url=}}</ref><ref name="pmid11702171">{{cite journal |vauthors=Dayanir YO, Akdilli A, Karaman CZ, Sönmez F, Karaman G |title=Epididymoorchitis mimicking testicular torsion in Henoch-Schönlein purpura |journal=Eur Radiol |volume=11 |issue=11 |pages=2267–9 |date=2001 |pmid=11702171 |doi=10.1007/s003300100843 |url=}}</ref><ref name="pmid22693978">{{cite journal |vauthors=Akgun C |title=A case of scrotal swelling mimicking testicular torsion preceding Henoch-Schönlein vasculitis |journal=Bratisl Lek Listy |volume=113 |issue=6 |pages=382–3 |date=2012 |pmid=22693978 |doi= |url=}}</ref>
+| style="background: #F5F5F5; padding: 5px; text-align: center;" |Unilateral
+| style="background: #F5F5F5; padding: 5px; text-align: center;" |Sudden
+| 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;" | +
+| 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;" | -
 | style="background: #F5F5F5; padding: 5px; text-align: left;" |
+* Serum IgA levels are elevated
+* Elevated ESR
+| style="background: #F5F5F5; padding: 5px; text-align: center;" | -
 | style="background: #F5F5F5; padding: 5px; text-align: left;" |
+* Sore throat 2-3 weeks back
+| style="background: #F5F5F5; padding: 5px; text-align: center;" |
+* Light microscopy shows  leukocytoclastic vasculitis in postcapillary venules with IgA deposition
+| style="background: #F5F5F5; padding: 5px; text-align: center;" |Biopsy
 | style="background: #F5F5F5; padding: 5px; text-align: left;" |
+* Palpable purpura
+* Age at onset is less than 20 years
+* Acute abdominal pain
+|-
+| style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Fourniers gangrene|Fournier's gangrene]]<ref name="pmid29146218">{{cite journal |vauthors=Voelzke BB, Hagedorn JC |title=Presentation and Diagnosis of Fournier Gangrene |journal=Urology |volume=114 |issue= |pages=8–13 |date=April 2018 |pmid=29146218 |doi=10.1016/j.urology.2017.10.031 |url=}}</ref><ref name="pmid28328332">{{cite journal |vauthors=Huang CS |title=Fournier's Gangrene |journal=N. Engl. J. Med. |volume=376 |issue=12 |pages=1158 |date=March 2017 |pmid=28328332 |doi=10.1056/NEJMicm1609306 |url=}}</ref><ref name="pmid29052826">{{cite journal |vauthors=Yücel M, Özpek A, Başak F, Kılıç A, Ünal E, Yüksekdağ S, Acar A, Baş G |title=Fournier's gangrene: A retrospective analysis of 25 patients |journal=Ulus Travma Acil Cerrahi Derg |volume=23 |issue=5 |pages=400–404 |date=September 2017 |pmid=29052826 |doi=10.5505/tjtes.2017.01678 |url=}}</ref><ref name="pmid26138056">{{cite journal |vauthors=Namkoong H, Ishii M, Koizumi M, Betsuyaku T |title=Fournier's gangrene: a surgical emergency |journal=Infection |volume=44 |issue=1 |pages=143–4 |date=February 2016 |pmid=26138056 |doi=10.1007/s15010-015-0816-4 |url=}}</ref>
+| style="background: #F5F5F5; padding: 5px; text-align: center;" |Bilateral
+| style="background: #F5F5F5; padding: 5px; text-align: center;" |Sudden
+| style="background: #F5F5F5; padding: 5px; text-align: center;" |<nowiki>+</nowiki>
+| 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: left;" |
+* Leukocytosis
+* Acidosis
+* Elevated ESR and CRP
+* Blood cultures are positive in majority of patient for streptococcus.
+| 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;" |
+* Computed tomography (CT) scan shows most useful finding is presence of gas in soft tissues.
 | style="background: #F5F5F5; padding: 5px; text-align: left;" |
-| style="background: #F5F5F5; padding: 5px; text-align: left;" |
+* Patient show signs of  tense edema outside the involved skin, blisters, bullae, crepitus, and subcutaneous gas.
-| style="background: #F5F5F5; padding: 5px; text-align: left;" |
-| style="background: #F5F5F5; padding: 5px; text-align: left;" |
-|
-| -
-| style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Brucellosis]]
-| 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;" |
-| 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;" |
-|
-|
-|
-|
-|
-|
-|
-|-
-|[[Histoplasmosis|Histoplasma]]
-|
-|
-|
-|
-|
-|
-|
-|
-|
-|
-|
-|
-|
-|
-|
-|
-|-
-|[[Antibiotic Resistant Gonorrhea|Gonorrhea]]
-|
-|
-|
-|
-|
-|
-|
-|
-|
-|
-|
-|
-|
-|
-|
-|
-|-
-|
-|[[Fourniers gangrene|Fournier's gangrene]]
-|
-|
-|
-|
-|
-|
-|
-|
-|
-|
-|
-|
-|
-|
-|
 |- style="background: #4479BA; color: #FFFFFF; text-align: center;"
-!Scrotal Swelling
 !Diseases
 !Unilateral /Bilateral swelling
@@ Line 240: / Line 291: @@
 ! colspan="1" rowspan="1" |Fever
 !Urinary symptoms
-!Tenderness
+!Tender<be>-ness
 !Erythema
 ! colspan="1" rowspan="1" |Discharge
@@ Line 252: / Line 303: @@
 !Additional findings
 |-
-| rowspan="8" |Painless
+! colspan="16" style="background: #7d7d7d; color: #FFFFFF; text-align: center;" |Painless
-| style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Fragile X syndrome|Fragile X]][[Macroorchidism]]
+|-
+| style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Fragile X syndrome|Fragile X]]   [[Macroorchidism]]<ref name="pmid6348096">{{cite journal |vauthors=Hagerman RJ, McBogg P, Hagerman PJ |title=The fragile X syndrome: history, diagnosis, and treatment |journal=J Dev Behav Pediatr |volume=4 |issue=2 |pages=122–30 |date=June 1983 |pmid=6348096 |doi= |url=}}</ref><ref name="pmid9678703">{{cite journal |vauthors=de Vries BB, Halley DJ, Oostra BA, Niermeijer MF |title=The fragile X syndrome |journal=J. Med. Genet. |volume=35 |issue=7 |pages=579–89 |date=July 1998 |pmid=9678703 |pmc=1051369 |doi= |url=}}</ref><ref name="pmid8190590">{{cite journal |vauthors=Lachiewicz AM, Dawson DV |title=Do young boys with fragile X syndrome have macroorchidism? |journal=Pediatrics |volume=93 |issue=6 Pt 1 |pages=992–5 |date=June 1994 |pmid=8190590 |doi= |url=}}</ref><ref name="pmid25767309">{{cite journal |vauthors=Saldarriaga W, Tassone F, González-Teshima LY, Forero-Forero JV, Ayala-Zapata S, Hagerman R |title=Fragile X syndrome |journal=Colomb. Med. |volume=45 |issue=4 |pages=190–8 |date=2014 |pmid=25767309 |pmc=4350386 |doi= |url=}}</ref>
 | style="background: #F5F5F5; padding: 5px;" |Bilateral
-| style="background: #F5F5F5; padding: 5px;" |
+| style="background: #F5F5F5; padding: 5px;" |Gradual
-| style="background: #F5F5F5; padding: 5px;" |
+| style="background: #F5F5F5; padding: 5px;" | -
-| 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;" |
+| style="background: #F5F5F5; padding: 5px;" | +
+| style="background: #F5F5F5; padding: 5px;" |Absent
 | style="background: #F5F5F5; padding: 5px;" | +
 | style="background: #F5F5F5; padding: 5px;" |
+* Normal
+| style="background: #F5F5F5; padding: 5px;" | -
+| style="background: #F5F5F5; padding: 5px;" | -
+| style="background: #F5F5F5; padding: 5px;" |Increased volume of testis
 | style="background: #F5F5F5; padding: 5px;" |
+* FMR1 DNA analysis
 | style="background: #F5F5F5; padding: 5px;" |
-| style="background: #F5F5F5; padding: 5px;" |
+* Long and narrow face with prominent forehead and chin (prognathism)
-| style="background: #F5F5F5; padding: 5px;" |
+* Large ears
-| style="background: #F5F5F5; padding: 5px;" |
+* Intellectual Disability
-| style="background: #F5F5F5; padding: 5px;" |
-| style="background: #F5F5F5; padding: 5px;" |
 |-
-| style="background: #DCDCDC; padding: 5px; text-align: center;" |Testicular Tumors
+| style="background: #DCDCDC; padding: 5px; text-align: center;" |Testicular Tumors<ref name="pmid28967388">{{cite journal |vauthors=Shen J, Bi Y, Wang X, Lu L, Tang L, Liu Y, Chen H, Zhang B |title=Epidemiologic study of 230 cases of testicular/paratesticular tumors or masses: 15-year experience of a single center |journal=J. Pediatr. Surg. |volume=52 |issue=12 |pages=2056–2060 |date=December 2017 |pmid=28967388 |doi=10.1016/j.jpedsurg.2017.08.027 |url=}}</ref><ref name="pmid25096628">{{cite journal |vauthors=Hohšteter M, Artuković B, Severin K, Kurilj AG, Beck A, Šoštarić-Zuckermann IC, Grabarević Ž |title=Canine testicular tumors: two types of seminomas can be differentiated by immunohistochemistry |journal=BMC Vet. Res. |volume=10 |issue= |pages=169 |date=August 2014 |pmid=25096628 |pmc=4129470 |doi=10.1186/s12917-014-0169-8 |url=}}</ref><ref name="pmid22677786">{{cite journal |vauthors=McDonald MW, Reed AB, Tran PT, Evans LA |title=Testicular tumor ultrasound characteristics and association with histopathology |journal=Urol. Int. |volume=89 |issue=2 |pages=196–202 |date=2012 |pmid=22677786 |doi=10.1159/000338771 |url=}}</ref><ref name="pmid28549629">{{cite journal |vauthors=Naouar S, Braiek S, El Kamel R |title=Testicular tumors of adrenogenital syndrome: From physiopathology to therapy |journal=Presse Med |volume=46 |issue=6 Pt 1 |pages=572–578 |date=June 2017 |pmid=28549629 |doi=10.1016/j.lpm.2017.05.006 |url=}}</ref>
 | style="background: #F5F5F5; padding: 5px;" |Unilateral or bilateral
 | style="background: #F5F5F5; padding: 5px;" |Gradual
 | style="background: #F5F5F5; padding: 5px;" |±
-| style="background: #F5F5F5; padding: 5px;" |
+| style="background: #F5F5F5; padding: 5px;" |Absent
 | style="background: #F5F5F5; padding: 5px;  text-align: center;" | ±
 | style="background: #F5F5F5; padding: 5px;" |
 | style="background: #F5F5F5; padding: 5px; text-align: center;" | +
+| style="background: #F5F5F5; padding: 5px;" |Present
+| style="background: #F5F5F5; padding: 5px;" | +
 | style="background: #F5F5F5; padding: 5px;" |
+* Increased serum beta-hCG or alpha fetoprotien (AFP)
+| style="background: #F5F5F5; padding: 5px;" | -
+| style="background: #F5F5F5; padding: 5px;" | -
+| style="background: #F5F5F5; padding: 5px;" |Seminoma  shows findings such as:
+* Large [[cells]] with watery [[cytoplasm]]
+* Fried egg [[appearance]]
 | style="background: #F5F5F5; padding: 5px;" |
+* Biopsy
 | style="background: #F5F5F5; padding: 5px;" |
-| style="background: #F5F5F5; padding: 5px;" |
+* Pain in the back or abdomen
-| style="background: #F5F5F5; padding: 5px;" |
+* [[Ascites]]
-| style="background: #F5F5F5; padding: 5px;" |
+* [[Weight loss]]
-| style="background: #F5F5F5; padding: 5px;" |
+* [[Gynecomastia]]
-| style="background: #F5F5F5; padding: 5px;" |
+* Precocious Puberty
+* [[Infertility]]
 |-
-| style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Henoch-Schönlein purpura|Henoch-Schonlein purpura]]
+| style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Hydrocele]]<ref name="pmid28551604">{{cite journal |vauthors=Costantino E, Ganesan GS, Plaire JC |title=Abdominoscrotal hydrocele in an infant boy |journal=BMJ Case Rep |volume=2017 |issue= |pages= |date=May 2017 |pmid=28551604 |doi=10.1136/bcr-2017-220370 |url=}}</ref><ref name="pmid26708803">{{cite journal |vauthors=Kaefer M, Agarwal D, Misseri R, Whittam B, Hubert K, Szymanski K, Rink R, Cain MP |title=Treatment of contralateral hydrocele in neonatal testicular torsion: Is less more? |journal=J Pediatr Urol |volume=12 |issue=5 |pages=306.e1–306.e4 |date=October 2016 |pmid=26708803 |doi=10.1016/j.jpurol.2015.07.009 |url=}}</ref><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><ref name="pmid28389795">{{cite journal |vauthors=Chen Y, Wang F, Zhong H, Zhao J, Li Y, Shi Z |title=A systematic review and meta-analysis concerning single-site laparoscopic percutaneous extraperitoneal closure for pediatric inguinal hernia and hydrocele |journal=Surg Endosc |volume=31 |issue=12 |pages=4888–4901 |date=December 2017 |pmid=28389795 |doi=10.1007/s00464-017-5491-3 |url=}}</ref><ref name="pmid21592287">{{cite journal |vauthors=Rioja J, Sánchez-Margallo FM, Usón J, Rioja LA |title=Adult hydrocele and spermatocele |journal=BJU Int. |volume=107 |issue=11 |pages=1852–64 |date=June 2011 |pmid=21592287 |doi=10.1111/j.1464-410X.2011.10353.x |url=}}</ref>
-| style="background: #F5F5F5; padding: 5px;" |
+| style="background: #F5F5F5; padding: 5px; text-align: center;" |Bilateral
-| style="background: #F5F5F5; padding: 5px;" |
-| style="background: #F5F5F5; padding: 5px;" |
-| style="background: #F5F5F5; padding: 5px;" |
-| 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;" |
-| 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: #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: left;" |Gradual
 | style="background: #F5F5F5; padding: 5px; text-align: center;" | -
@@ Line 314: / Line 364: @@
 | 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;" |
+* Normal
-| 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;" | -
-| style="background: #F5F5F5; padding: 5px; text-align: left;" |[[Ultrasound|Ultrasound:]]
+| style="background: #F5F5F5; padding: 5px; text-align: left;" |
-simple fluid collection
+* [[Ultrasound|Ultrasound:]] simple fluid collection
-| style="background: #F5F5F5; padding: 5px; text-align: left;" |Transillumination test +ve.
+| style="background: #F5F5F5; padding: 5px; text-align: left;" |
+* Transillumination test is positive
 |-
-| 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="pmid28865534">{{cite journal |vauthors=Clavijo RI, Carrasquillo R, Ramasamy R |title=Varicoceles: prevalence and pathogenesis in adult men |journal=Fertil. Steril. |volume=108 |issue=3 |pages=364–369 |date=September 2017 |pmid=28865534 |doi=10.1016/j.fertnstert.2017.06.036 |url=}}</ref><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><ref name="pmid28851509">{{cite journal |vauthors=Locke JA, Noparast M, Afshar K |title=Treatment of varicocele in children and adolescents: A systematic review and meta-analysis of randomized controlled trials |journal=J Pediatr Urol |volume=13 |issue=5 |pages=437–445 |date=October 2017 |pmid=28851509 |doi=10.1016/j.jpurol.2017.07.008 |url=}}</ref><ref name="pmid26806081">{{cite journal |vauthors=Shridharani A, Owen RC, Elkelany OO, Kim ED |title=The significance of clinical practice guidelines on adult varicocele detection and management |journal=Asian J. Androl. |volume=18 |issue=2 |pages=269–75 |date=2016 |pmid=26806081 |doi=10.4103/1008-682X.172641 |url=}}</ref>
 | style="background: #F5F5F5; padding: 5px; text-align: left;" |Unilateral
 (Mainly left)
@@ Line 333: / Line 385: @@
 | 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: center;" |
+* Elevations in unstimulated luteinizing hormone and follicle stimulating hormone levels  may be seen in when associated with infertility in adults
-| style="background: #F5F5F5; padding: 5px; text-align: center;" |
+| style="background: #F5F5F5; padding: 5px; text-align: left;" |
+* Thrombosis of Inferiror vena cava
+* Thrombosis of Right renal vein
+* Abdominal mass
+| style="background: #F5F5F5; padding: 5px; text-align: left;" |
 * [[Renal cancer]]
 * [[Nephrectomy]]
 * Nut-cracker syndrome
-| 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;" | -
-| 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]]
 | style="background: #F5F5F5; padding: 5px; text-align: left;" |
-| style="background: #F5F5F5; padding: 5px; text-align: center;" | -
+* 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]]
-| 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;" |
+* Infertility
+|-
+| 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><ref name="pmid21592287">{{cite journal |vauthors=Rioja J, Sánchez-Margallo FM, Usón J, Rioja LA |title=Adult hydrocele and spermatocele |journal=BJU Int. |volume=107 |issue=11 |pages=1852–64 |date=June 2011 |pmid=21592287 |doi=10.1111/j.1464-410X.2011.10353.x |url=}}</ref><ref name="pmid17606432">{{cite journal |vauthors=Yeh HC, Wang CJ, Liu CC, Wu WJ, Chou YH, Huang CH |title=Giant spermatocele mimicking hydrocele: a case report |journal=Kaohsiung J. Med. Sci. |volume=23 |issue=7 |pages=366–9 |date=July 2007 |pmid=17606432 |doi=10.1016/S1607-551X(09)70423-1 |url=}}</ref>
+| style="background: #F5F5F5; padding: 5px; text-align: left;" |Unilateral
 | 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;" |Absent
 | style="background: #F5F5F5; padding: 5px; text-align: left;" |<nowiki>-</nowiki>
 | style="background: #F5F5F5; padding: 5px; text-align: left;" |<nowiki>-</nowiki>
@@ Line 354: / Line 411: @@
 | style="background: #F5F5F5; padding: 5px; text-align: left;" |Absent
 | style="background: #F5F5F5; padding: 5px; text-align: center;" | +
+| style="background: #F5F5F5; padding: 5px; text-align: left;" | -
 | style="background: #F5F5F5; padding: 5px; text-align: left;" |
+* Falling snow, resulting from internal echoes moving away from the transducer
 | style="background: #F5F5F5; padding: 5px; text-align: left;" |
-* Falling snow, resulting from internal echoes moving away from the transducer
+* Epididymitis
+* Trauma
 | style="background: #F5F5F5; padding: 5px; text-align: left;" |
+* Epididymal scarring is seen
 | style="background: #F5F5F5; padding: 5px; text-align: left;" |
-| style="background: #F5F5F5; padding: 5px; text-align: left;" |[[Ultrasonography]]:
+* [[Ultrasonography]]: hypoechoic with posterior acoustic enhancement
-hypoechoic with posterior acoustic enhancement
 | style="background: #F5F5F5; padding: 5px; text-align: left;" |
+* Transillumination test is positive
 |-
-| 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;" |Scrotal edema<ref name="pmid28316300">{{cite journal |vauthors=Geffre M, Maki C, Maier S |title=Acute Scrotal Edema in Cirrhotic after Laparoscopic Cholecystectomy |journal=Am Surg |volume=83 |issue=3 |pages=e93–95 |date=March 2017 |pmid=28316300 |doi= |url=}}</ref><ref name="pmid28625172">{{cite journal |vauthors=Esposito F, Sanchez O, Siebert JN, Manzano S |title=Acute scrotal idiopathic edema: A misleading erythema |journal=CJEM |volume=20 |issue=S2 |pages=S37 |date=October 2018 |pmid=28625172 |doi=10.1017/cem.2017.343 |url=}}</ref>
-|style="background: #F5F5F5; padding: 5px; text-align: center;" |
+| style="background: #F5F5F5; padding: 5px; text-align: center;" |Bilateral and can extend to perineum
-|style="background: #F5F5F5; padding: 5px; text-align: center;" |
+| style="background: #F5F5F5; padding: 5px; text-align: center;" |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;" |
+| 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;" |
+| 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;" |Absent
+| style="background: #F5F5F5; padding: 5px; text-align: center;" |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;" |
-|style="background: #F5F5F5; padding: 5px; text-align: center;" |
+* [[Eosinophilia]]
-|style="background: #F5F5F5; padding: 5px; text-align: center;" |
+* Hypoalbuminemia
-|style="background: #F5F5F5; padding: 5px; text-align: center;" |
+* Hyperlipidemia.
-|style="background: #F5F5F5; padding: 5px; text-align: center;" |
+* Proteinurea
-|style="background: #F5F5F5; padding: 5px; text-align: center;" |
+| style="background: #F5F5F5; padding: 5px; text-align: center;" |
+* Deep Vein Thrombosis
+| style="background: #F5F5F5; padding: 5px; text-align: center;" |
+* Nephrotic Syndrome
+* Hepatic Cirrhosis
+* Insect Bite
+| style="background: #F5F5F5; padding: 5px; text-align: center;" | -
+| style="background: #F5F5F5; padding: 5px; text-align: center;" |
+* Kidney or Liver biopsy
+| style="background: #F5F5F5; padding: 5px; text-align: center;" |
+* Occurs between 4-12 years of age.
 |-
-| style="background: #DCDCDC; padding: 5px; text-align: center;" |Scrotal eodema
+| style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Sebaceous cyst]]<ref name="pmid26400592">{{cite journal |vauthors=Solanki A, Narang S, Kathpalia R, Goel A |title=Scrotal calcinosis: pathogenetic link with epidermal cyst |journal=BMJ Case Rep |volume=2015 |issue= |pages= |date=September 2015 |pmid=26400592 |pmc=4593290 |doi=10.1136/bcr-2015-211163 |url=}}</ref><ref name="pmid25297369">{{cite journal |vauthors=Prasad KK, Manjunath RD |title=Multiple epidermal cysts of scrotum |journal=Indian J. Med. Res. |volume=140 |issue=2 |pages=318 |date=August 2014 |pmid=25297369 |pmc=4216510 |doi= |url=}}</ref><ref name="pmid25015622">{{cite journal |vauthors=Ząbkowski T, Wajszczuk M |title=Epidermoid cyst of the scrotum: a clinical case |journal=Urol J |volume=11 |issue=3 |pages=1706–9 |date=July 2014 |pmid=25015622 |doi= |url=}}</ref>
-|style="background: #F5F5F5; padding: 5px; text-align: center;" |Bilateral and can extend to perineum
+| style="background: #F5F5F5; padding: 5px; text-align: center;" |Unilateral
-|style="background: #F5F5F5; padding: 5px; text-align: center;" |
+| style="background: #F5F5F5; padding: 5px; text-align: center;" |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;" |
+| 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;" | -
-|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;" |<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;" |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;" |[[Eosinophilia]]
+| 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;" |
+* Normal
-|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: left;" |
-|style="background: #F5F5F5; padding: 5px; text-align: center;" |Occurs between 4-12 years of age.
+* [[Fibrous tissues]] and fluids
+* A fatty,([[keratinous]]), substance that resembles cottage cheese,.
+* A viscous, serosanguinous fluid (containing [[purulent]] and bloody material).
+| style="background: #F5F5F5; padding: 5px; text-align: center;" |
+* Histological examination
+| style="background: #F5F5F5; padding: 5px; text-align: center;" |
+* Freely movable on palpation.
 |-
-| 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;" |[[Scrotum Carcinoma|Carcinoma of the scrotum]]<ref name="pmid21791720">{{cite journal |vauthors=Casasola Chamorro J, Gutiérrez García S, de Blas Gómez V |title=Scrotal carcinoma |journal=Arch. Esp. Urol. |volume=64 |issue=6 |pages=541–3 |date=July 2011 |pmid=21791720 |doi= |url=}}</ref><ref name="pmid26113906">{{cite journal |vauthors=Halfya A, Elmortaji K, Redouane R, Fethi M, Rafik A, Mohamed E, Abdessamad C |title=[Squamous cell carcinomas of the scrotum: about 7 cases with review of the literature] |language=French |journal=Pan Afr Med J |volume=20 |issue= |pages=163 |date=2015 |pmid=26113906 |pmc=4469445 |doi=10.11604/pamj.2015.20.163.5991 |url=}}</ref><ref name="pmid26959967">{{cite journal |vauthors=Armas-Alvarez AL, Salinas-Sánchez AS, Atienzar-Tobarra M, Virseda-Rodríguez JA |title=Scrotal tumors |journal=Arch. Esp. Urol. |volume=69 |issue=2 |pages=86–9 |date=March 2016 |pmid=26959967 |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: center;" |
+| style="background: #F5F5F5; padding: 5px; text-align: center;" |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;" |
+| style="background: #F5F5F5; padding: 5px; text-align: center;" |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;" | -
-|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: 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;" | -
-|style="background: #F5F5F5; padding: 5px; text-align: center;" |
+| style="background: #F5F5F5; padding: 5px; text-align: center;" |
-|style="background: #F5F5F5; padding: 5px; text-align: center;" |
+* Normal
-|style="background: #F5F5F5; padding: 5px; text-align: center;" |
+| style="background: #F5F5F5; padding: 5px; text-align: center;" | -
-|style="background: #F5F5F5; padding: 5px; text-align: center;" |Ultrasonography:
+| style="background: #F5F5F5; padding: 5px; text-align: left;" |
-posterior acoustic enhancement, well defined anechoic lesions, larger cysts may contain septations
+* keratinocytic dysplasia involving the full thickness of the epidermis without infiltration of atypical cells into the dermis.
-|
+* The keratinocytes are pleomorphic with hyperchromatic nuclei
+* Numerous mitoses are present.
+| style="background: #F5F5F5; padding: 5px; text-align: center;" |
+* Biopsy
+| style="background: #F5F5F5; padding: 5px; text-align: center;" |
+* Scaly patch or plaque is seen over the testis.
 |-
-|
+| style="background: #DCDCDC; padding: 5px; text-align: center;" |[[filariasis|Chylocele]] ([[Filariasis]])<ref name="pmid25989164">{{cite journal |vauthors=Otabil KB, Tenkorang SB |title=Filarial hydrocele: a neglected condition of a neglected tropical disease |journal=J Infect Dev Ctries |volume=9 |issue=5 |pages=456–62 |date=March 2015 |pmid=25989164 |doi=10.3855/jidc.5346 |url=}}</ref><ref name="pmid28507911">{{cite journal |vauthors=Janssen KM, Willis CJ, Anderson M, Gelnett MS, Wickersham EL, Brand TC |title=Filariasis Orchitis-Differential for Acute Scrotum Pathology |journal=Urol Case Rep |volume=13 |issue= |pages=117–119 |date=July 2017 |pmid=28507911 |pmc=5426035 |doi=10.1016/j.eucr.2017.04.002 |url=}}</ref><ref name="pmid21771446">{{cite journal |vauthors=Yagain K, Mathew M |title=Filariasis presenting as a scrotal nodule in a 2 year old child: a case report |journal=Asian Pac J Trop Med |volume=4 |issue=2 |pages=167–8 |date=February 2011 |pmid=21771446 |doi=10.1016/S1995-7645(11)60062-X |url=}}</ref>
-| style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Sebaceous cyst]]
+| style="background: #F5F5F5; padding: 5px; text-align: center;" |Unilateral or Bilateral
-|style="background: #F5F5F5; padding: 5px; text-align: center;" |
+| style="background: #F5F5F5; padding: 5px; text-align: center;" |Gradually
-|style="background: #F5F5F5; padding: 5px; text-align: center;" |
+Rapidly
-|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;" |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;" | -
-|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: 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: left;" |
-|style="background: #F5F5F5; padding: 5px; text-align: center;" |
+* Circulating filarial antigen (CFA) assays are positve
-|style="background: #F5F5F5; padding: 5px; text-align: center;" |
+| style="background: #F5F5F5; padding: 5px; text-align: left;" |
-|style="background: #F5F5F5; padding: 5px; text-align: center;" |
+* Lymphatics containing worms can be differentiated from the blood vessels by irregular movement
-|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;" |
+* CFA assay
+| style="background: #F5F5F5; padding: 5px; text-align: left;" |
+* Ultrasound demonstrates living worms which has been described as  "filarial dance" sign.
 |-
-|
+| style="background: #DCDCDC; padding: 5px; text-align: center;" |Scrotoliths<ref name="pmid21935341">{{cite journal |vauthors=Khallouk A, Yazami OE, Mellas S, Tazi MF, El Fassi J, Farih MH |title=Idiopathic scrotal calcinosis: a non-elucidated pathogenesis and its surgical treatment |journal=Rev Urol |volume=13 |issue=2 |pages=95–7 |date=2011 |pmid=21935341 |pmc=3176555 |doi= |url=}}</ref><ref name="pmid16836500">{{cite journal |vauthors=Noël B, Bron C, Künzle N, De Heller M, Panizzon RG |title=Multiple nodules of the scrotum: histopathological findings and surgical procedure. A study of five cases |journal=J Eur Acad Dermatol Venereol |volume=20 |issue=6 |pages=707–10 |date=July 2006 |pmid=16836500 |doi=10.1111/j.1468-3083.2006.01578.x |url=}}</ref><ref name="pmid8790314">{{cite journal |vauthors=Polk P, McCutchen WT, Phillips JG, Biggs PJ |title=Polypoid scrotal calcinosis: an uncommon variant of scrotal calcinosis |journal=South. Med. J. |volume=89 |issue=9 |pages=896–7 |date=September 1996 |pmid=8790314 |doi= |url=}}</ref>
-| style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Scrotum Carcinoma|Carcinoma of the scrotum]]
+| style="background: #F5F5F5; padding: 5px; text-align: center;" |Unilateral
-|style="background: #F5F5F5; padding: 5px; text-align: center;" |
+| style="background: #F5F5F5; padding: 5px; text-align: center;" |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;" |
+| style="background: #F5F5F5; padding: 5px; text-align: center;" |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;" | -
-|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: 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;" | -
-|style="background: #F5F5F5; padding: 5px; text-align: center;" |
+| style="background: #F5F5F5; padding: 5px; text-align: center;" |
-|style="background: #F5F5F5; padding: 5px; text-align: center;" |
+* Normal
-|style="background: #F5F5F5; padding: 5px; text-align: center;" |
+| style="background: #F5F5F5; padding: 5px; text-align: left;" |
-|style="background: #F5F5F5; padding: 5px; text-align: center;" |
+* Trauma
-|style="background: #F5F5F5; padding: 5px; text-align: center;" |
+* Torsion of appendix
-|
+| style="background: #F5F5F5; padding: 5px; text-align: center;" | -
-|-
+| style="background: #F5F5F5; padding: 5px; text-align: center;" |
-|
+* Ultrasound
-| style="background: #DCDCDC; padding: 5px; text-align: center;" |[[filariasis|Chylocele]] ([[Filariasis]])
+| style="background: #F5F5F5; padding: 5px; text-align: left;" |
-|style="background: #F5F5F5; padding: 5px; text-align: center;" |
+* Ultrasound shows  mobile hyperechoic extratesticular focus in the potential tunica space.
-|style="background: #F5F5F5; padding: 5px; text-align: center;" |Gradually/Rapidly
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-| style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Congenital cystic dysplasia|Cystic dysplasia]]
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-| style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Srotoliths]]
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 |}

Scrotal mass differential diagnosis: Difference between revisions

Latest revision as of 15:16, 23 October 2019

Overview

Differentiating Scrotal masses from the other Diseases

References

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