Scrotal mass diagnostic study of choice

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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

If there is an acutely painful scrotum,there should be a strong suspicion for testicular torsion, which is an emergency condition, and emergent surgical referral should be strongly considered. Sonography may be performed if testicular torsion is not suspected to confirm the diagnosis. Testicular torsion is primrily diagnosed base on the clinical presentation.

Diagnostic Study of Choice

Study of choice

• Ultrasonography of the scrotom is the gold standard test for the differentiated diagnosis of scrotal mass.

• Colored ultrasonography is specific and sensitive test for the diagnosis of epididymitis.

• Testicular tortion is primarily diagnosed based on the clinical presentation.

Investigations:

• Among the patients who present with clinical signs of epididymitis, the colored ultrasonography is the most specific test for the diagnosis.
• Among the patients who present with clinical signs of epididymitis, the colored ultrasonography is the most sensitive test for diagnosis.

The comparison of various diagnostic studies for Testicular mass

Test	Sensitivity	Specificity	disease
ultrasonography	94	96	Tosticular Tortion
colored ultrasonography	100	90-100	Epididymitis Diagnostic results The following finding(s) on performing [investigation name] is(are) confirmatory for [disease name]: [Finding 1] [Finding 2] Sequence of Diagnostic Studies The [name of investigation] must be performed when: The patient presented with symptoms/signs 1, 2, and 3 as the first step of diagnosis. A positive [test] is detected in the patient, to confirm the diagnosis. OR The various investigations must be performed in the following order: [Initial investigation] [2nd investigation] Name of Diagnostic Criteria It is recommended that you include the criteria in a table. Make sure you always cite the source of the content and whether the table has been adapted from another source. [Disease name] is primarily diagnosed based on clinical presentation. There are no established criteria for the diagnosis of [disease name]. OR There is no single diagnostic study of choice for [disease name], though [disease name] may be diagnosed based on [name of criteria] established by [...]. OR The diagnosis of [disease name] is made when at least [number] of the following [number] diagnostic criteria are met: [criterion 1], [criterion 2], [criterion 3], and [criterion 4]. OR The diagnosis of [disease name] is based on the [criteria name] criteria, which includes [criterion 1], [criterion 2], and [criterion 3]. OR [Disease name] may be diagnosed at any time if one or more of the following criteria are met: Criteria 1 Criteria 2 Criteria 3 OR IF there are clear, established diagnostic criteria The diagnosis of [disease name] is made when at least [number] of the following [number] diagnostic criteria are met: [criterion 1], [criterion 2], [criterion 3], and [criterion 4]. OR The diagnosis of [disease name] is based on the [criteria name] criteria, which include [criterion 1], [criterion 2], and [criterion 3]. OR The diagnosis of [disease name] is based on the [definition name] definition, which includes [criterion 1], [criterion 2], and [criterion 3]. OR IF there are no established diagnostic criteria There are no established criteria for the diagnosis of [disease name]. References Evaluation of Scrotal Mass If there is an acutely painful scrotum,there should be a strong suspicion for testicular torsion, which is an emergency condition, and emergent surgical referral should be strongly considered. Sonography may be performed if testicular torsion is not suspected to confirm the diagnosis. The evaluation of scrotal mass is as follows:                             Evaluation of the scrotal mass                                                                                                           Painful                           Nonpainful                                                                     High-riding or horizontal testicle; nausea/vomiting?                           Transilluminates?                                                                                                                     Yes           No           Yes           No                                                                         Presumed torsion Doppler ultrasonogram, urology consult           Blue dot sign?           Hydrocele           "Bag of worms" on palpation that increases on Valsalva maneuvers                                                                                                                                   Yes           No           Yes           No                                                                                       Torsion of testicular appendage           Lack of blood flow on doppler sonogram, C-reactive protein level <24 mg per L           Varicocele           Reducible mass?                                                                                                                                                   Yes           No           Yes           No                                                                                                         Testicular torsion; urgent surgery           Likely epididymitis/orchitis, possibly incarcerated inguinal hernia, or hemorrhagic testicular cancer           Hernia           Extratesticular and nontender                                                                                                                                                                           Yes           No                                                                                                                                                   Likely benign, further workup as needed           Doppler sonography prior to urology evaluation                                                                                                                                                                 Unilateral mass                                                                                                                                                                   Evaluate for testicular cancer: AFP, B-HCG, and LDH levels; MRI or CT scans may be considered to look for possible metastases and cryopreservation of sperm while awaiting urology evaluation   Adapted from American academy of family physicians. References