Scrotal mass differential diagnosis: Difference between revisions

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__NOTOC__
__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==
==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.


==Differential Diagnosis==
==Differentiating Scrotal masses from the other Diseases==
 
[[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;"
! 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'''
! colspan="4" rowspan="2" style="background: #4479BA; color: #FFFFFF; text-align: center;" |Para-clinical findings
| colspan="1" rowspan="4" style="background: #4479BA; color: #FFFFFF; text-align: center;" |'''Gold standard'''
! rowspan="4" style="background: #4479BA; color: #FFFFFF; text-align: center;" |Associated
|-
| colspan="4" rowspan="2" style="background: #4479BA; color: #FFFFFF; text-align: center;" |'''Symptoms'''
! colspan="5" rowspan="2" style="background: #4479BA; color: #FFFFFF; text-align: center;" |Physical examination
|-
! colspan="2" style="background: #4479BA; color: #FFFFFF; text-align: center;" |Lab Findings
! rowspan="2" style="background: #4479BA; color: #FFFFFF; text-align: center;" |Past Medical History
! rowspan="2" style="background: #4479BA; color: #FFFFFF; text-align: center;" |Histopathology
|-
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Unilateral /Bilateral swelling
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Onset
! 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;" |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
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Inguinal Lymphadenopathy
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Cremasteric Reflex
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Blood/Urine Analysis
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Doppler U/S
|-
! colspan="16" style="background: #7d7d7d; color: #FFFFFF; text-align: center;" |Painful
|-
| 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;" |±
| style="background: #F5F5F5; padding: 5px;" |Dysuria, frequency, and/or urgency
| style="background: #F5F5F5; padding: 5px; text-align: center;" | +
| style="background: #F5F5F5; padding: 5px; text-align: center;" | -
| 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;" |
* CBC-[[Leukocytosis]]
* 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]].
* [[Chronic]] cases are characterized by [[granulomatous]] [[inflammation]].
| style="background: #F5F5F5; padding: 5px;" |
* [[Ultrasound]] for diagnosis ([[Testicular masses]]<nowiki/>or swollen [[testicles]] with hypoechoic and hypervascular areas)
| style="background: #F5F5F5; padding: 5px;" |
* [[Hydrocele]]
* [[Urinary tract infection]]
* Gonococcal infection
* chlamydia infection
* Phen sign +ve
|-
| style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Orchitis]]
[[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
| style="background: #F5F5F5; padding: 5px; text-align: center;" |±
| style="background: #F5F5F5; padding: 5px;" |Dysuria
| 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;" |
* 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
* Concurrent [[epididymitis]]
* [[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;" |
* Phen sign +ve
* Testicular atrophy
* Infertility
|-
| 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;" |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;" |Absent
| style="background: #F5F5F5; padding: 5px; text-align: center;" | -
| style="background: #F5F5F5; padding: 5px;" |
* Normal
| style="background: #F5F5F5; padding: 5px;" |
* Absent or decreased arterial perfusion of the testis
| style="background: #F5F5F5; padding: 5px;" |
* Previous history of [[testicular torsion]]
*<nowiki/>[[Family history]]<nowiki/> of [[testicular torsion]]
* [[Prematurity]]
*<nowiki/>[[Undescended testes]]
* [[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: #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; " |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;" |
* Increased destruction and fibrosis of the dartos fascia,.
* Dense inflammatory cells, necrotic areas and destruction of the muscular layer.
| style="background: #F5F5F5; padding: 5px; text-align: left;" |
* Ultrasonography: to check for testicular rupture.
| 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>
| style="background: #F5F5F5; padding: 5px; text-align: left;" |Unilateral
| style="background: #F5F5F5; padding: 5px; text-align: left;" |Sudden
| 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: 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: 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;" |
* [[Acute]] infection is characterized by infiltration of [[neutrophils]].
* [[Chronic]] cases are characterized by [[granulomatous]] [[inflammation]].
| 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;" |
* 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;" |
* Patient show signs of  tense edema outside the involved skin, blisters, bullae, crepitus, and subcutaneous gas.
|- style="background: #4479BA; color: #FFFFFF; text-align: center;"
!Diseases
!Unilateral /Bilateral swelling
!Onset
! colspan="1" rowspan="1" |Fever
!Urinary symptoms
!Tender<be>-ness
!Erythema
! colspan="1" rowspan="1" |Discharge
!Inguinal Lymphadenopathy
!Cremasteric Reflex
!Blood/Urine Analysis
!Doppler U/S
!Past Medical History
!Histopathology
|'''Gold standard'''
!Additional findings
|-
! 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]]<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;" |Gradual
| 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;" |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;" |
* Long and narrow face with prominent forehead and chin (prognathism)
* Large ears
* Intellectual Disability
|-
| 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;" |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;" |
* Pain in the back or abdomen
* [[Ascites]]
* [[Weight loss]]
* [[Gynecomastia]]
* Precocious Puberty
* [[Infertility]]
|-
| 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; text-align: center;" |Bilateral
| 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;" |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: 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;" |
* Normal
| 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:]] simple fluid collection
| style="background: #F5F5F5; padding: 5px; text-align: left;" |
* Transillumination test is positive
|-
| 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)
| 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;" |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: left;" |Absent
| style="background: #F5F5F5; padding: 5px; text-align: center;" | +
| style="background: #F5F5F5; padding: 5px; text-align: left;" |
* 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: 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;" | -
| 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;" |
* 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;" |Absent
| 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: 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;" |
* Epididymitis
* Trauma
| style="background: #F5F5F5; padding: 5px; text-align: left;" |
* Epididymal scarring is seen
| style="background: #F5F5F5; padding: 5px; text-align: left;" |
* [[Ultrasonography]]: 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;" |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;" |Bilateral and can extend to perineum
| 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;" |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;" |Absent
| style="background: #F5F5F5; padding: 5px; text-align: center;" | +
| style="background: #F5F5F5; padding: 5px; text-align: center;" |
* [[Eosinophilia]]
* Hypoalbuminemia
* Hyperlipidemia.
* Proteinurea
| 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;" |[[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;" |Unilateral
| 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;" |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;" | -
| 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;" |
* [[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;" |[[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;" |Gradual
| 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: 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;" |
* Normal
| style="background: #F5F5F5; padding: 5px; text-align: center;" | -
| style="background: #F5F5F5; padding: 5px; text-align: left;" |
* 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: #F5F5F5; padding: 5px; text-align: center;" |Unilateral or Bilateral
| style="background: #F5F5F5; padding: 5px; text-align: center;" |Gradually
Rapidly
| 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: left;" |Absent
| style="background: #F5F5F5; padding: 5px; text-align: center;" | +
| style="background: #F5F5F5; padding: 5px; text-align: left;" |
* Circulating filarial antigen (CFA) assays are positve
| style="background: #F5F5F5; padding: 5px; text-align: left;" |
* 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;" |
* 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: #F5F5F5; padding: 5px; text-align: center;" |Unilateral
| 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;" |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;" |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;" |
* Normal
| style="background: #F5F5F5; padding: 5px; text-align: left;" |
* Trauma
* Torsion of appendix
| style="background: #F5F5F5; padding: 5px; text-align: center;" | -
| style="background: #F5F5F5; padding: 5px; text-align: center;" |
* Ultrasound
| style="background: #F5F5F5; padding: 5px; text-align: left;" |
* Ultrasound shows  mobile hyperechoic extratesticular focus in the potential tunica space.
|}
 
[[Category:Disease]]
[[Category:Types of cancer]]
[[Category:Oncology]]


==References==
==References==
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[[Category:Oncology]]
[[Category:Oncology]]


{{WS}}
[[Category:Up-To-Date]]
{{WH}}
[[Category:Oncology]]
[[Category:Medicine]]
[[Category:Urology]]

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.

Diseases Clinical manifestations Para-clinical findings Gold standard Associated
Symptoms Physical examination
Lab Findings Past Medical History Histopathology
Unilateral /Bilateral swelling Onset Fever Urinary symptoms Tender
-ness 		Erythema Discharge Inguinal Lymphadenopathy Cremasteric Reflex Blood/Urine Analysis Doppler U/S
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
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.
  • 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
  • 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
  • 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:
  • 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
 -
  • 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:
  • Biopsy
Hydrocele[51][52][53][54][55] Bilateral Gradual - Absent - - - Absent + -
  • Normal
 - -
  • 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
 -
  • 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
  • Transillumination test is positive
Scrotal edema[62][63] Bilateral and can extend to perineum Gradual - Absent - - - Absent +
  • 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

  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. ↑ Manavi K, Turner K, Scott GR, Stewart LH (May 2005). "Audit on the management of epididymo-orchitis by the Department of Urology in Edinburgh". Int J STD AIDS. 16 (5): 386–7. doi:10.1258/0956462053888853. PMID 15949072.
  3. ↑ Lee YS, Kim SW, Han SW (2018). "Different managements for prepubertal epididymitis based on a preexisting genitourinary anomaly diagnosis". PLoS ONE. 13 (4): e0194761. doi:10.1371/journal.pone.0194761. PMC 5905873. PMID 29668706.
  4. ↑ Ralls PW, Jensen MC, Lee KP, Mayekawa DS, Johnson MB, Halls JM (June 1990). "Color Doppler sonography in acute epididymitis and orchitis". J Clin Ultrasound. 18 (5): 383–6. PMID 2161009.
  5. ↑ Michel V, Pilatz A, Hedger MP, Meinhardt A (2015). "Epididymitis: revelations at the convergence of clinical and basic sciences". Asian J. Androl. 17 (5): 756–63. doi:10.4103/1008-682X.155770. PMC 4577585. PMID 26112484.
  6. ↑ Tracy CR, Costabile RA (April 2009). "The evaluation and treatment of acute epididymitis in a large university based population: are CDC guidelines being followed?". World J Urol. 27 (2): 259–63. doi:10.1007/s00345-008-0338-0. PMID 19002691.
  7. ↑ 7.0 7.1 7.2 Pepe P, Panella P, Pennisi M, Aragona F (October 2006). "Does color Doppler sonography improve the clinical assessment of patients with acute scrotum?". Eur J Radiol. 60 (1): 120–4. doi:10.1016/j.ejrad.2006.04.016. PMID 16730939.
  8. ↑ 8.0 8.1 Ludwig M (April 2008). "Diagnosis and therapy of acute prostatitis, epididymitis and orchitis". Andrologia. 40 (2): 76–80. doi:10.1111/j.1439-0272.2007.00823.x. PMID 18336454.
  9. ↑ Davis NF, McGuire BB, Mahon JA, Smyth AE, O'Malley KJ, Fitzpatrick JM (April 2010). "The increasing incidence of mumps orchitis: a comprehensive review". BJU Int. 105 (8): 1060–5. doi:10.1111/j.1464-410X.2009.09148.x. PMID 20070300.
  10. ↑ CHARNY CW, MERANZE DR (July 1948). "Pathology of mumps orchitis". J. Urol. 60 (1): 140–6. PMID 18873054.
  11. ↑ Bjorvatn B (1973). "Mumps virus recovered from testicles by fine-needle aspiration biopsy in cases of mumps orchitis". Scand. J. Infect. Dis. 5 (1): 3–5. PMID 4580293.
  12. ↑ Beard CM, Benson RC, Kelalis PP, Elveback LR, Kurland LT (January 1977). "The incidence and outcome of mumps orchitis in Rochester, Minnesota, 1935 to 1974". Mayo Clin. Proc. 52 (1): 3–7. PMID 609284.
  13. ↑ Gall EA (July 1947). "The Histopathology of Acute Mumps Orchitis". Am. J. Pathol. 23 (4): 637–51. PMC 1934294. PMID 19970951.
  14. ↑ Başekim CC, Kizilkaya E, Pekkafali Z, Baykal KV, Karsli AF (2000). "Mumps epididymo-orchitis: sonography and color Doppler sonographic findings". Abdom Imaging. 25 (3): 322–5. PMID 10823460.
  15. ↑ Hazeltine M, Panza A, Ellsworth P (2017). "Testicular Torsion: Current Evaluation and Management". Urol Nurs. 37 (2): 61–71, 93. PMID 29240370.
  16. ↑ Estremadoyro V, Meyrat BJ, Birraux J, Vidal I, Sanchez O (February 2017). "[Diagnosis and management of testicular torsion in children]". Rev Med Suisse (in French). 13 (550): 406–410. PMID 28714632.
  17. ↑ Sharp VJ, Kieran K, Arlen AM (December 2013). "Testicular torsion: diagnosis, evaluation, and management". Am Fam Physician. 88 (12): 835–40. PMID 24364548.
  18. ↑ Mikuz G (1985). "Testicular torsion: simple grading for histological evaluation of tissue damage". Appl Pathol. 3 (3): 134–9. PMID 3842075.
  19. ↑ 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.
  20. ↑ Bowen DK, Gonzalez CM (2014). "Intratesticular hematoma after blunt scrotal trauma: a case series and algorithm-based approach to management". Cent European J Urol. 67 (4): 427–9. doi:10.5173/ceju.2014.04.art24. PMC 4310892. PMID 25667770.
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  37. ↑ Dayanir YO, Akdilli A, Karaman CZ, Sönmez F, Karaman G (2001). "Epididymoorchitis mimicking testicular torsion in Henoch-Schönlein purpura". Eur Radiol. 11 (11): 2267–9. doi:10.1007/s003300100843. PMID 11702171.
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  58. ↑ Locke JA, Noparast M, Afshar K (October 2017). "Treatment of varicocele in children and adolescents: A systematic review and meta-analysis of randomized controlled trials". J Pediatr Urol. 13 (5): 437–445. doi:10.1016/j.jpurol.2017.07.008. PMID 28851509.
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  63. ↑ Esposito F, Sanchez O, Siebert JN, Manzano S (October 2018). "Acute scrotal idiopathic edema: A misleading erythema". CJEM. 20 (S2): S37. doi:10.1017/cem.2017.343. PMID 28625172.
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  70. ↑ Otabil KB, Tenkorang SB (March 2015). "Filarial hydrocele: a neglected condition of a neglected tropical disease". J Infect Dev Ctries. 9 (5): 456–62. doi:10.3855/jidc.5346. PMID 25989164.
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  74. ↑ Noël B, Bron C, Künzle N, De Heller M, Panizzon RG (July 2006). "Multiple nodules of the scrotum: histopathological findings and surgical procedure. A study of five cases". J Eur Acad Dermatol Venereol. 20 (6): 707–10. doi:10.1111/j.1468-3083.2006.01578.x. PMID 16836500.
  75. ↑ 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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