Scrotal mass physical examination: Difference between revisions

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




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===HEENT===
===HEENT===
* HEENT examination of patients with scrotal mass is usually normal.
* HEENT examination of patients with scrotal mass is usually normal.
OR
* Abnormalities of the head/hair may include ___
* Evidence of trauma
* Icteric sclera
* [[Nystagmus]]
* Extra-ocular movements may be abnormal
*Pupils non-reactive to light / non-reactive to accommodation / non-reactive to neither light nor accommodation
*Ophthalmoscopic exam may be abnormal with findings of ___
* Hearing acuity may be reduced
*[[Weber test]] may be abnormal (Note: A positive Weber test is considered a normal finding / A negative Weber test is considered an abnormal finding. To avoid confusion, you may write "abnormal Weber test".)
*[[Rinne test]] may be positive (Note: A positive Rinne test is considered a normal finding / A negative Rinne test is considered an abnormal finding. To avoid confusion, you may write "abnormal Rinne test".)
* [[Exudate]] from the ear canal
* Tenderness upon palpation of the ear pinnae/tragus (anterior to ear canal)
*Inflamed nares / congested nares
* [[Purulent]] exudate from the nares
* Facial tenderness
* Erythematous throat with/without tonsillar swelling, exudates, and/or petechiae


===Neck===
===Neck===
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===Heart===
===Heart===
* Cardiovascular examination of patients with [disease name] is usually normal.
* Cardiovascular examination of patients with scrotal mass is usually normal.
OR
*Chest tenderness upon palpation
*PMI within 2 cm of the sternum  (PMI) / Displaced point of maximal impulse (PMI) suggestive of ____
*[[Heave]] / [[thrill]]
*[[Friction rub]]
*[[Heart sounds#First heart tone S1, the "lub"(components M1 and T1)|S1]]
*[[Heart sounds#Second heart tone S2 the "dub"(components A2 and P2)|S2]]
*[[Heart sounds#Third heart sound S3|S3]]
*[[Heart sounds#Fourth heart sound S4|S4]]
*[[Heart sounds#Summation Gallop|Gallops]]
*A high/low grade early/late [[systolic murmur]] / [[diastolic murmur]] best heard at the base/apex/(specific valve region) may be heard using the bell/diaphgram of the stethoscope


===Abdomen===
===Abdomen===
* Abdominal examination of patients with [disease name] is usually normal.
* Abdominal examination of patients with scrotal mass is usually normal.
OR
*Paitient with scrotal cancer with metastetis may present with :
*[[Abdominal distension]]  
*[[Abdominal distension]]  
*[[Abdominal tenderness]] in the right/left upper/lower abdominal quadrant
*[[Abdominal tenderness]]  
*[[Rebound tenderness]] (positive Blumberg sign)
* Abdominal mass
*A palpable abdominal mass in the right/left upper/lower abdominal quadrant
*Guarding may be present
*[[Hepatomegaly]] / [[splenomegaly]] / [[hepatosplenomegaly]]
*Additional findings, such as obturator test, psoas test, McBurney point test, Murphy test


===Back===
===Back===
* Back examination of patients with [disease name] is usually normal.
* Back examination of patients with scrotal mass is usually normal.
OR
*Point tenderness over __ vertebrae (e.g. L3-L4)
*Sacral edema
*Costovertebral angle tenderness bilaterally/unilaterally
*Buffalo hump


===Genitourinary===
===Genitourinary===
* Genitourinary examination of patients with [disease name] is usually normal.
*Swallon testis
OR
*Abnormal testis position
*A pelvic/adnexal mass may be palpated
*Bag of worms on palpation
*Inflamed mucosa
*Tender and palpable nodule
*Clear/(color), foul-smelling/odorless penile/vaginal discharge
*Absence of cremasteric reflex
*Posetive tranillumination


===Neuromuscular===
===Neuromuscular===
* Neuromuscular examination of patients with [disease name] is usually normal.
* Neuromuscular examination of patients with scrotal mass is usually normal.
OR
*Patient is usually oriented to persons, place, and time
* Altered mental status
* Glasgow coma scale is ___ / 15
* Clonus may be present
* Hyperreflexia / hyporeflexia / areflexia
* Positive (abnormal) Babinski / plantar reflex unilaterally/bilaterally
* Muscle rigidity
* Proximal/distal muscle weakness unilaterally/bilaterally
* ____ (finding) suggestive of cranial nerve ___ (roman numerical) deficit (e.g. Dilated pupils suggestive of CN III deficit)
*Unilateral/bilateral upper/lower extremity weakness
*Unilateral/bilateral sensory loss in the upper/lower extremity
*Positive straight leg raise test
*Abnormal gait (describe gait: e.g. ataxic (cerebellar) gait / steppage gait / waddling gait / choeiform gait / Parkinsonian gait / sensory gait)
*Positive/negative Trendelenburg sign
*Unilateral/bilateral tremor (describe tremor, e.g. at rest, pill-rolling)
*Normal finger-to-nose test / Dysmetria
*Absent/present dysdiadochokinesia (palm tapping test)


===Extremities===
===Extremities===
* Extremities examination of patients with [disease name] is usually normal.
* Extremities examination of patients with scrotal mass is usually normal.
OR
*[[Clubbing]]
*[[Cyanosis]]
*Pitting/non-pitting [[edema]] of the upper/lower extremities
*Muscle atrophy
*Fasciculations in the upper/lower extremity


==References==
==References==

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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