Scrotal mass physical examination: Difference between revisions

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==Overview==
==Overview==
Common physical examination findings of scrotal mass include swelling and tender mass which is having a smooth, twisted, or irregular shape and liquid, firm, or solid in consistency. The ipsilateral [[inguinal lymph nodes]] may be enlarged or tender.
[[Physical culture|physical]] [[Ex-Lax Chocolated|examination]] of scrotal masses depends on causes.common [[Physical Examination|physical]] [[Physical examination|examinations]] in [[Testicular cancer|testicular tortion]] is an elevated ,[[Hoarding disorder|horizontlly]] aligned testicle.
Also they have severe [[tenderness]] and [[Firmacort|firm]] in palpation.[[Cremasteric reflex|Cremastic reflex]] and [[Phrenic|phren sign]] are absent.In [[testicular]] [[Apalutamide|apendix]] [[Tortilla Wall|tortion]] ,[[Phacetoperane|phathognomonic sign]] is [[Blubber|Blue dot]],which is a [[Nodule (medicine)|nodule]] with [[Blue|blue discoloration]].In [[Hydrocele MRI|hydrocele]] [[transillumination]] test will be positive.


==Evaluation of Scrotal Mass==
==Physical Evaluation==
The physical examination findings of scrotal mass depend on the cause of the mass. The likely diagnoses of a scrotal mass based on physical examination findings include:<ref name=pescrotalmass1>Evaluation of scrotal mass. American academy of family physicians 2016. http://www.aafp.org/afp/2008/1115/p1165.html. Accessed on March 22, 2016</ref>
 
===Swelling of the Testis===
<br>
 
{{familytree/start |summary=Swelling of the testis}}
{{familytree |boxstyle=background: #DCDCDC;| | | | | | | | | | | | | | | A01 |A01=<div style="width: 9em; padding:0.2em;">'''Swelling of the testis'''</div>}}
{{familytree |boxstyle=background: #DCDCDC;| | | | | | | |,|-|-|-|-|-|-|-|^|-|-|-|-|-|-|-|.| | |}}
{{familytree |boxstyle=background: #DCDCDC;| | | | | | | B01 | | | | | | | | | | | | | | B02 | |B01=<div style="width: 9em; padding:0.2em;">Tender, onset <24 hours</div>|B02=<div style="width: 9em; padding:0.2em;">Nontender, gradual onset</div>}}
{{familytree |boxstyle=background: #DCDCDC;| | | | | | | |!| | | | | | | | | | | |,|-|-|-|^|-|-|-|.| |}}
{{familytree |boxstyle=background: #DCDCDC;| | | | | | | C01 | | | | | | | | | | C02 | | | | | | C03 |C01=<div style="width: 9em; padding:0.2em;">Torsion versus orchitis</div>|C02=<div style="width: 9em; padding:0.2em;">Solid</div>|C03=<div style="width: 9em; padding:0.2em;">Transilluminates</div>}}
{{familytree |boxstyle=background: #DCDCDC;| | | | | | | |!| | | | | | | | | | | |!| | | | | | | |!| |}}
{{familytree |boxstyle=background: #DCDCDC;| | | | | | | D01 | | | | | | | | | | D02 | | | | | | D03 | |D01=<div style="width: 9em; padding:0.2em;">Emergent surgical referral</div>|D02=<div style="width: 9em; padding:0.2em;">Suspect testicular cancer; order sonography or refer</div>|D03=<div style="width: 9em; padding:0.2em;">Yes</div>|D03=<div style="width: 9em; padding:0.2em;">Hydrocele obscuring testis; order sonography to confirm</div>}}
{{familytree/end}}
<SMALL>Adapted from American academy of family physicians.<ref name=pescrotalmass1>Evaluation of scrotal mass. American academy of family physicians 2016. http://www.aafp.org/afp/2008/1115/p1165.html. Accessed on March 22, 2016</ref></SMALL>
 
===Swelling of the Epididymis===
<br>
 
 
{{familytree/start |summary=Swelling of the epididymis}}
{{familytree |boxstyle=background: #DCDCDC;| | | | | | | | | | | | | | | A01 |A01=<div style="width: 9em; padding:0.2em;">'''Swelling of the epididymis'''</div>}}
{{familytree |boxstyle=background: #DCDCDC;| | | | | | | |,|-|-|-|-|-|-|-|^|-|-|-|-|-|-|-|.| | |}}
{{familytree |boxstyle=background: #DCDCDC;| | | | | | | B01 | | | | | | | | | | | | | | B02 | |B01=<div style="width: 9em; padding:0.2em;">Diffusely swollen, tender, acute onset</div>|B02=<div style="width: 9em; padding:0.2em;">Nodule, stable in size</div>}}
{{familytree |boxstyle=background: #DCDCDC;| | | | | | | |!| | | | | | | | | | | | | | | |!| | | |}}
{{familytree |boxstyle=background: #DCDCDC;| | | | | | | C01 | | | | | | | | | | | | | | C02 | | | |C01=<div style="width: 9em; padding:0.2em;">Epididymitis</div>|C02=<div style="width: 9em; padding:0.2em;">Spermatocele; sonography to confirm</div>}}
{{familytree/end}}
<SMALL>Adapted from American academy of family physicians.<ref name=pescrotalmass1>Evaluation of scrotal mass. American academy of family physicians 2016. http://www.aafp.org/afp/2008/1115/p1165.html. Accessed on March 22, 2016</ref></SMALL>
 
===Swelling of the Spermatic Cord===
<br>
 
 
{{familytree/start |summary=Swelling of the spermatic cord}}
{{familytree |boxstyle=background: #DCDCDC;| | | | | | | | | | | | | | | A01 |A01=<div style="width: 9em; padding:0.2em;">'''Swelling of the spermatic cord'''</div>}}
{{familytree |boxstyle=background: #DCDCDC;| | | | | | | |,|-|-|-|-|-|-|-|+|-|-|-|-|-|-|-|.| | |}}
{{familytree |boxstyle=background: #DCDCDC;| | | | | | | B01 | | | | | | B02 | | | | | | B03 | |B01=<div style="width: 9em; padding:0.2em;">Swelling extends to inguinal ring</div>|B02=<div style="width: 9em; padding:0.2em;">"Bag of worms" texture</div>|B03=<div style="width: 9em; padding:0.2em;">Smooth, transilluminates</div>}}
{{familytree |boxstyle=background: #DCDCDC;| | | | | | | |!| | | | | | | |!| | | | | | | |!| | | |}}
{{familytree |boxstyle=background: #DCDCDC;| | | | | | | C01 | | | | | | C02 | | | | | | C03 | | | |C01=<div style="width: 9em; padding:0.2em;">Indirect inguinal hernia</div>|C02=<div style="width: 9em; padding:0.2em;">Varicocele</div>|C03=<div style="width: 9em; padding:0.2em;">Hydrocele</div>}}
{{familytree/end}}
<SMALL>Adapted from American academy of family physicians.<ref name=pescrotalmass1>Evaluation of scrotal mass. American academy of family physicians 2016. http://www.aafp.org/afp/2008/1115/p1165.html. Accessed on March 22, 2016</ref></SMALL>
 
===Swelling of the Skin===
<br>
 
 
{{familytree/start |summary=Swelling of the skin}}
{{familytree |boxstyle=background: #DCDCDC;| | | | | | | | | | | | | | | A01 |A01=<div style="width: 9em; padding:0.2em;">'''Swelling of the skin'''</div>}}
{{familytree |boxstyle=background: #DCDCDC;| | | | | | | |,|-|-|-|-|-|-|-|^|-|-|-|-|-|-|-|.| | |}}
{{familytree |boxstyle=background: #DCDCDC;| | | | | | | B01 | | | | | | | | | | | | | | B02 | |B01=<div style="width: 9em; padding:0.2em;">Irregular, enlarging; occupational risk</div>|B02=<div style="width: 9em; padding:0.2em;">Smooth, cystic, stable in size</div>}}
{{familytree |boxstyle=background: #DCDCDC;| | | | | | | |!| | | | | | | | | | | | | | | |!| | |}}
{{familytree |boxstyle=background: #DCDCDC;| | | | | | | C01 | | | | | | | | | | | | | | C02 |C01=<div style="width: 9em; padding:0.2em;">TRule out squamous cell carcinoma</div>|C02=<div style="width: 9em; padding:0.2em;">Sebaceous cyst</div>}}
{{familytree/end}}
<SMALL>Adapted from American academy of family physicians.<ref name=pescrotalmass1>Evaluation of scrotal mass. American academy of family physicians 2016. http://www.aafp.org/afp/2008/1115/p1165.html. Accessed on March 22, 2016</ref></SMALL>
 
==Physical Examination==
 
 
Physical examination of patients with testicular tortion is usually remarkable for horizontally aligned testicle, absence of cremasteric reflex, and phern sign.<ref name="pmid26757064">{{cite journal| author=OʼReilly P, Le J, Sinyavskaya A, Mandel ED| title=Evaluating scrotal masses. | journal=JAAPA | year= 2016 | volume= 29 | issue= 2 | pages= 26-32 | pmid=26757064 | doi=10.1097/01.JAA.0000476208.04443.ca | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=26757064  }} </ref>
 
The presence of blu dot sign on physical examination is diagnostic of testicular appendix tortion.<ref name="pmid26757064">{{cite journal| author=OʼReilly P, Le J, Sinyavskaya A, Mandel ED| title=Evaluating scrotal masses. | journal=JAAPA | year= 2016 | volume= 29 | issue= 2 | pages= 26-32 | pmid=26757064 | doi=10.1097/01.JAA.0000476208.04443.ca | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=26757064  }} </ref>
 
The presence of bag of worms on physical examination is highly suggestive of varicocele.<ref name="pmid25598931">{{cite journal| author=Gordhan CG, Sadeghi-Nejad H| title=Scrotal pain: evaluation and management. | journal=Korean J Urol | year= 2015 | volume= 56 | issue= 1 | pages= 3-11 | pmid=25598931 | doi=10.4111/kju.2015.56.1.3 | pmc=4294852 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=25598931  }} </ref>
 
The presence of transillumination test on physical examination is highly suggestive of hydrocele.<ref name="pmid25598931">{{cite journal| author=Gordhan CG, Sadeghi-Nejad H| title=Scrotal pain: evaluation and management. | journal=Korean J Urol | year= 2015 | volume= 56 | issue= 1 | pages= 3-11 | pmid=25598931 | doi=10.4111/kju.2015.56.1.3 | pmc=4294852 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=25598931  }} </ref>
 
 
===Appearance of the Patient===
*Depond on the cause of scrotal mass is different.
 
*Patients with painfull scrotal usually appear ill and patients without pain usually apear normal.
 
===Vital Signs===
 
*In epididymitis may have low-grade fever
 
===Skin===
* Skin examination of patients with scrotal mass is usually normal.
*In epididymitis scrotal skin on the affected side may be erythematous.
 
 
<gallery widths="150px">
 
UploadedImage-01.jpg | Description {{dermref}}
UploadedImage-02.jpg | Description {{dermref}}
 
</gallery>
 
===HEENT===
* HEENT examination of patients with scrotal mass is usually normal.
 
===Neck===
* Neck examination of patients with scrotal mass is usually normal.
*Patients with scrotal cancer with metastesis may present with neck mass.
 
===Lungs===
* Pulmonary examination of patients with scrotal mass is usually normal.
 
===Heart===
* Cardiovascular examination of patients with scrotal mass is usually normal.
 
===Abdomen===
* Abdominal examination of patients with scrotal mass is usually normal.
*Paitient with scrotal cancer with metastetis may present with :
*[[Abdominal distension]]
*[[Abdominal tenderness]]
* Abdominal mass
 
===Back===
* Back examination of patients with scrotal mass is usually normal.
 
===Genitourinary===
*Swallon testis
*Abnormal testis position
*Bag of worms on palpation
*Tender and palpable nodule
*Absence of cremasteric reflex
*Posetive tranillumination
 
===Neuromuscular===
* Neuromuscular examination of patients with scrotal mass is usually normal.
 
===Extremities===
* Extremities examination of patients with scrotal mass is usually normal.


==References==
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==References==
==References==
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[[Category:Up-To-Date]]
[[Category:Oncology]]
[[Category:Medicine]]
[[Category:Urology]]

Latest revision as of 16:50, 16 December 2019

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

Overview

Common physical examination findings of scrotal mass include swelling and tender mass which is having a smooth, twisted, or irregular shape and liquid, firm, or solid in consistency. The ipsilateral inguinal lymph nodes may be enlarged or tender. physical examination of scrotal masses depends on causes.common physical examinations in testicular tortion is an elevated ,horizontlly aligned testicle. Also they have severe tenderness and firm in palpation.Cremastic reflex and phren sign are absent.In testicular apendix tortion ,phathognomonic sign is Blue dot,which is a nodule with blue discoloration.In hydrocele transillumination test will be positive.

Physical Evaluation

The physical examination findings of scrotal mass depend on the cause of the mass. The likely diagnoses of a scrotal mass based on physical examination findings include:[1]

Swelling of the Testis


 
 
 
 
 
 
 
 
 
 
 
 
 
 
Swelling of the testis
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Tender, onset <24 hours
 
 
 
 
 
 
 
 
 
 
 
 
 
Nontender, gradual onset
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Torsion versus orchitis
 
 
 
 
 
 
 
 
 
Solid
 
 
 
 
 
Transilluminates
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Emergent surgical referral
 
 
 
 
 
 
 
 
 
Suspect testicular cancer; order sonography or refer
 
 
 
 
 
Hydrocele obscuring testis; order sonography to confirm
 

Adapted from American academy of family physicians.[1]

Swelling of the Epididymis



 
 
 
 
 
 
 
 
 
 
 
 
 
 
Swelling of the epididymis
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Diffusely swollen, tender, acute onset
 
 
 
 
 
 
 
 
 
 
 
 
 
Nodule, stable in size
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Epididymitis
 
 
 
 
 
 
 
 
 
 
 
 
 
Spermatocele; sonography to confirm
 
 
 

Adapted from American academy of family physicians.[1]

Swelling of the Spermatic Cord



 
 
 
 
 
 
 
 
 
 
 
 
 
 
Swelling of the spermatic cord
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Swelling extends to inguinal ring
 
 
 
 
 
"Bag of worms" texture
 
 
 
 
 
Smooth, transilluminates
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Indirect inguinal hernia
 
 
 
 
 
Varicocele
 
 
 
 
 
Hydrocele
 
 
 

Adapted from American academy of family physicians.[1]

Swelling of the Skin



 
 
 
 
 
 
 
 
 
 
 
 
 
 
Swelling of the skin
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Irregular, enlarging; occupational risk
 
 
 
 
 
 
 
 
 
 
 
 
 
Smooth, cystic, stable in size
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
TRule out squamous cell carcinoma
 
 
 
 
 
 
 
 
 
 
 
 
 
Sebaceous cyst

Adapted from American academy of family physicians.[1]

Physical Examination

Physical examination of patients with testicular tortion is usually remarkable for horizontally aligned testicle, absence of cremasteric reflex, and phern sign.[2]

The presence of blu dot sign on physical examination is diagnostic of testicular appendix tortion.[2]

The presence of bag of worms on physical examination is highly suggestive of varicocele.[3]

The presence of transillumination test on physical examination is highly suggestive of hydrocele.[3]


Appearance of the Patient

  • Depond on the cause of scrotal mass is different.
  • Patients with painfull scrotal usually appear ill and patients without pain usually apear normal.

Vital Signs

  • In epididymitis may have low-grade fever

Skin

  • Skin examination of patients with scrotal mass is usually normal.
  • In epididymitis scrotal skin on the affected side may be erythematous.


HEENT

  • HEENT examination of patients with scrotal mass is usually normal.

Neck

  • Neck examination of patients with scrotal mass is usually normal.
  • Patients with scrotal cancer with metastesis may present with neck mass.

Lungs

  • Pulmonary examination of patients with scrotal mass is usually normal.

Heart

  • Cardiovascular examination of patients with scrotal mass is usually normal.

Abdomen

Back

  • Back examination of patients with scrotal mass is usually normal.

Genitourinary

  • Swallon testis
  • Abnormal testis position
  • Bag of worms on palpation
  • Tender and palpable nodule
  • Absence of cremasteric reflex
  • Posetive tranillumination

Neuromuscular

  • Neuromuscular examination of patients with scrotal mass is usually normal.

Extremities

  • Extremities examination of patients with scrotal mass is usually normal.

References

  1. ↑ 1.0 1.1 1.2 1.3 1.4 Evaluation of scrotal mass. American academy of family physicians 2016. http://www.aafp.org/afp/2008/1115/p1165.html. Accessed on March 22, 2016
  2. ↑ 2.0 2.1 OʼReilly P, Le J, Sinyavskaya A, Mandel ED (2016). "Evaluating scrotal masses". JAAPA. 29 (2): 26–32. doi:10.1097/01.JAA.0000476208.04443.ca. PMID 26757064.
  3. ↑ 3.0 3.1 Gordhan CG, Sadeghi-Nejad H (2015). "Scrotal pain: evaluation and management". Korean J Urol. 56 (1): 3–11. doi:10.4111/kju.2015.56.1.3. PMC 4294852. PMID 25598931.

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References

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