Scrotal mass differential diagnosis: Difference between revisions
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! rowspan="4" style="background: #4479BA; color: #FFFFFF; text-align: center;" |Associated | ! rowspan="4" style="background: #4479BA; color: #FFFFFF; text-align: center;" |Associated | ||
|- | |- | ||
| rowspan=" | | rowspan="12" style="background: #4479BA; color: #FFFFFF; text-align: center;" |Painful | ||
| colspan="4" rowspan="2" style="background: #4479BA; color: #FFFFFF; text-align: center;" |'''Symptoms''' | | 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="5" rowspan="2" style="background: #4479BA; color: #FFFFFF; text-align: center;" |Physical examination | ||
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! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Doppler U/S | ! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Doppler U/S | ||
|- | |- | ||
| style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Epididymoorchitis]]<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> | | 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> | ||
| style="background: #F5F5F5; padding: 5px;" |Unilateral | | style="background: #F5F5F5; padding: 5px;" |Unilateral | ||
| style="background: #F5F5F5; padding: 5px;" |Gradual | | style="background: #F5F5F5; padding: 5px;" |Gradual | ||
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| style="background: #F5F5F5; padding: 5px;" |Pyuria | | style="background: #F5F5F5; padding: 5px;" |Pyuria | ||
| style="background: #F5F5F5; padding: 5px;" | | | style="background: #F5F5F5; padding: 5px;" | | ||
| style="background: #F5F5F5; padding: 5px;" |+ | |||
| style="background: #F5F5F5; padding: 5px;" | | | style="background: #F5F5F5; padding: 5px;" | | ||
[[Leukocytosis]] | |||
| style="background: #F5F5F5; padding: 5px;" | | | style="background: #F5F5F5; padding: 5px;" | | ||
| style="background: #F5F5F5; padding: 5px;" |[[Hydrocele]] | | style="background: #F5F5F5; padding: 5px;" |[[Hydrocele]] | ||
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* [[Acute]] infection is characterized by infiltration of [[neutrophils]]. | * [[Acute]] infection is characterized by infiltration of [[neutrophils]]. | ||
* [[Chronic]] cases are characterized by [[granulomatous]] [[inflammation]]. | * [[Chronic]] cases are characterized by [[granulomatous]] [[inflammation]]. | ||
| style="background: #F5F5F5; padding: 5px;" | | | style="background: #F5F5F5; padding: 5px;" | | ||
* [[Ultrasound]] for diagnosis ([[Testicular masses]]<nowiki/>or swollen [[testicles]] with hypoechoic and hypervascular areas) | |||
| style="background: #F5F5F5; padding: 5px;" | | |||
|- | |||
|[[Orchitis]] | |||
|Unilateral or bilateral | |||
|Abrupt | |||
|± | |||
|± | |||
| + | |||
|_ | |||
| | |||
| | |||
| + | |||
|[[Leukocytosis]] | |||
| | |||
| | |||
* [[Mumps]], [[Coxsackie virus|coxsackie]]<nowiki/>virus infection | |||
* Concurrent [[epididymitis]] | |||
* [[Congenital disorder|Congenital abnornmalities]] | |||
| | |||
| | |||
* [[Ultrasound]] for diagnosis ([[Testicular masses]]<nowiki/>or swollen [[testicles]] with hypoechoic and hypervascular areas) | |||
| | |||
|- | |- | ||
| style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Testicular torsion|Testicular Torsion]]<ref name="pmid16724203">{{cite journal |vauthors=Gunther P, Schenk JP, Wunsch R, Holland-Cunz S, Kessler U, Troger J, Waag KL |title=Acute testicular torsion in children: the role of sonography in the diagnostic workup |journal=Eur Radiol |volume=16 |issue=11 |pages=2527–32 |date=November 2006 |pmid=16724203 |doi=10.1007/s00330-006-0287-1 |url=}}</ref> | | style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Testicular torsion|Testicular Torsion]]<ref name="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> | ||
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| style="background: #F5F5F5; padding: 5px;" | | | style="background: #F5F5F5; padding: 5px;" | | ||
| style="background: #F5F5F5; padding: 5px;" | + | | style="background: #F5F5F5; padding: 5px;" | + | ||
| style="background: #F5F5F5; padding: 5px;" |+ | | style="background: #F5F5F5; padding: 5px;" | + | ||
| style="background: #F5F5F5; padding: 5px;" |_ | | style="background: #F5F5F5; padding: 5px;" |_ | ||
| style="background: #F5F5F5; padding: 5px;" | | | style="background: #F5F5F5; padding: 5px;" | | ||
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| style="background: #F5F5F5; padding: 5px;" |Absent or decreased arterial perfusion of the testis | | style="background: #F5F5F5; padding: 5px;" |Absent or decreased arterial perfusion of the testis | ||
| style="background: #F5F5F5; padding: 5px;" | | | style="background: #F5F5F5; padding: 5px;" | | ||
* Previous history of [[testicular torsion]] | |||
* [[Family history]]<nowiki/>of [[testicular torsion]] | |||
* [[Prematurity]] | |||
* [[Undescended testes]] | |||
* [[Low birth weight]] | |||
| style="background: #F5F5F5; padding: 5px;" | | | style="background: #F5F5F5; padding: 5px;" | | ||
| style="background: #F5F5F5; padding: 5px;" | | | style="background: #F5F5F5; padding: 5px;" | | ||
* [[Doppler ultrasound]]> [[Computed tomography|CT scan]] | |||
| style="background: #F5F5F5; padding: 5px;" | | | style="background: #F5F5F5; padding: 5px;" | | ||
|- | |- | ||
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| style="background: #F5F5F5; padding: 5px;" |Unilateral | | style="background: #F5F5F5; padding: 5px;" |Unilateral | ||
| style="background: #F5F5F5; padding: 5px;" |Sudden | | style="background: #F5F5F5; padding: 5px;" |Sudden | ||
| style="background: #F5F5F5; padding: 5px;" |- | | style="background: #F5F5F5; padding: 5px;" | - | ||
| style="background: #F5F5F5; padding: 5px;" | | | style="background: #F5F5F5; padding: 5px;" | | ||
| style="background: #F5F5F5; padding: 5px;" | + | | style="background: #F5F5F5; padding: 5px;" | + | ||
| style="background: #F5F5F5; padding: 5px;" |+ | | style="background: #F5F5F5; padding: 5px;" | + | ||
| style="background: #F5F5F5; padding: 5px;" |_ | | style="background: #F5F5F5; padding: 5px;" |_ | ||
| style="background: #F5F5F5; padding: 5px;" | | | style="background: #F5F5F5; padding: 5px;" | | ||
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| style="background: #F5F5F5; padding: 5px;" | | | style="background: #F5F5F5; padding: 5px;" | | ||
| style="background: #F5F5F5; padding: 5px;" | | | style="background: #F5F5F5; padding: 5px;" | | ||
| style="background: #F5F5F5; padding: 5px;" | | | style="background: #F5F5F5; padding: 5px;" | | ||
* [[Doppler ultrasound]]> [[Computed tomography|CT scan]] | |||
| style="background: #F5F5F5; padding: 5px;" |prepubertal period | | style="background: #F5F5F5; padding: 5px;" |prepubertal period | ||
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Revision as of 18:08, 23 January 2019
Scrotal Mass Microchapters |
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]Associate Editor(s)-in-Chief: Sujit Routray, M.D. [2]
Overview
Scrotal masses may be differentiated according to clinical features, laboratory findings, imaging features, histological features, and genetic studies from other diseases that cause testicular mass with discomfort, back pain, abdominal discomfort, or abdominal mass. Common differential diagnoses include yolk sac tumor, teratoma, choriocarcinoma, embryonal cell carcinoma, seminoma, and testicular lymphoma (usually non-Hodgkin lymphoma).
Differential Diagnosis
The table below summarizes the findings that differentiates scrotal mass according to the clinical features, laboratory findings, imaging features, histological features, and genetic studies.
Scrotal Swelling | Diseases | Clinical manifestations | Para-clinical findings | Gold standard | Associated | |||||||||||
---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
Painful | Symptoms | Physical examination | ||||||||||||||
Lab Findings | Past Medical History | Histopathology | ||||||||||||||
Unilateral /Bilateral swelling | Onset | Fever | Urinary symptoms | Tenderness | Erythema | Discharge | Inguinal Lymphadenopathy | Cremasteric Reflex | Urine Analysis | Doppler U/S | ||||||
Epididymitis[1] | Unilateral | Gradual | ± | Dysuria, frequency, and/or urgency | + | _ | Pyuria | + | Hydrocele |
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Orchitis | Unilateral or bilateral | Abrupt | ± | ± | + | _ | + | Leukocytosis |
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Testicular Torsion[2] | Unilateral | Sudden | - | + | + | _ | _ | Normal | Absent or decreased arterial perfusion of the testis |
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Torsion of testicular appendix | Unilateral | Sudden | - | + | + | _ | _ | Normal | Absent or decreased arterial perfusion of the testis | prepubertal period | ||||||
Hematocele | + | |||||||||||||||
Incarcerated Hernia | - | |||||||||||||||
Testicular Abcess | - | |||||||||||||||
Brucellosis | - | |||||||||||||||
Mumps | - | |||||||||||||||
Histoplasma | ||||||||||||||||
Gonorrhea | ||||||||||||||||
Fournier's gangrene | ||||||||||||||||
Scrotal Swelling | Diseases | Unilateral /Bilateral swelling | Lab 3 | Fever | Urinary symptoms | Tenderness | Erythema | Discharge | Inguinal Lymphadenopathy | Cremasteric Reflex | Urine Analysis | Doppler U/S | Past Medical History | Histopathology | Gold standard | Additional findings |
Painless | Fragile XMacroorchidism | - | + | |||||||||||||
Testicular Tumors | - | + | ||||||||||||||
Henoch-Schonlein purpura | - | - | ||||||||||||||
Hydrocele | - | - | ||||||||||||||
Varicocele | - | - | ||||||||||||||
Spermatocele | - | - | ||||||||||||||
Inguino-scrotal hernia | - | - | ||||||||||||||
Scrotal edema | - | - | ||||||||||||||
Epididymal cyst | ||||||||||||||||
Scrotal oedema | ||||||||||||||||
Sebaceous cyst | ||||||||||||||||
Carcinoma of the scrotum | ||||||||||||||||
Chylocele (Filariasis) | ||||||||||||||||
Cystic dysplasia | ||||||||||||||||
Srotoliths |
References
- ↑ 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.
- ↑ 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.