Scrotal mass differential diagnosis: Difference between revisions

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Revision as of 18:28, 23 January 2019

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.

		Symptoms				Physical examination					Lab Findings		Past Medical History	Histopathology
Scrotal Swelling	Diseases	Clinical manifestations									Para-clinical findings				Gold standard	Associated
Painful		Symptoms				Physical examination					Para-clinical findings
		Unilateral /Bilateral swelling	Onset	Fever	Urinary symptoms	Tenderness	Erythema	Discharge	Inguinal Lymphadenopathy	Cremasteric Reflex	Urine Analysis	Doppler U/S	Past Medical History	Histopathology
	Epididymitis^[1]	Unilateral	Gradual	±	Dysuria, frequency, and/or urgency	+	_	Pyuria		+	Leukocytosis	Enlarged (>17 mm) epididymis with a hypoechoic, hyperechoic, or heterogeneous echotexture, increased blood flow	Hydrocele	Acute infection is characterized by infiltration of neutrophils. Chronic cases are characterized by granulomatous inflammation.	Ultrasound for diagnosis (Testicular massesor swollen testicles with hypoechoic and hypervascular areas)
	Orchitis	Unilateral or bilateral	Abrupt	±	±	+	-	±		+	Leukocytosis		Mumps, coxsackievirus infection Concurrent epididymitis Congenital abnornmalities		Ultrasound for diagnosis (Testicular massesor swollen testicles with hypoechoic and hypervascular areas)
	Testicular Torsion^[2]	Unilateral	Sudden	-		+	+	Blood in semen		-	Normal	Absent or decreased arterial perfusion of the testis	Previous history of testicular torsion Family history of testicular torsion Prematurity Undescended testes Low birth weight		Doppler ultrasound> CT scan
	Torsion of testicular appendix	Unilateral	Sudden	-		+	+	-		-	Normal	Absent or decreased arterial perfusion of the testis	Prematurity Undescended testes Low birth weight		Doppler ultrasound> CT scan	prepubertal period
	Hematocele	Unilateral or bilateral	Sudden	-		+	+	Blood in semen
	Incarcerated Hernia^[3]^[4]	Unilateral	Sudden	+	-	+	+	-
	Testicular Abcess					-
	Brucellosis					-
	Histoplasma
	Gonorrhea
	Fournier's gangrene

Scrotal Swelling	Diseases	Unilateral /Bilateral swelling	Onset	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		Gradual	_		-	-	-							Ultrasound: simple fluid collection
	Varicocele		Gradual	Local warmth		-	±	-							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
	Spermatocele		Gradual			-	-	-				Falling snow, resulting from internal echoes moving away from the transducer			Ultrasonography: hypoechoic with posterior acoustic enhancement
	Inguino-scrotal hernia^[5]^[3]					-		-
	Scrotal edema					-		-
	Epididymal cyst					±									Ultrasonography:: posterior acoustic enhancement, well defined anechoic lesions, larger cysts may contain septations
	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.
↑ ^3.0 ^3.1 Jenkins JT, O'Dwyer PJ (2008). "Inguinal hernias". BMJ. 336 (7638): 269–72. doi:10.1136/bmj.39450.428275.AD. PMC 2223000. PMID 18244999.
↑ Berger D (2016). "Evidence-Based Hernia Treatment in Adults". Dtsch Arztebl Int. 113 (9): 150–7, quiz 158. doi:10.3238/arztebl.2016.0150. PMC 4802357. PMID 26987468.
↑ Berger D (2016). "Evidence-Based Hernia Treatment in Adults". Dtsch Arztebl Int. 113 (9): 150–7, quiz 158. doi:10.3238/arztebl.2016.0150. PMC 4802357. PMID 26987468.

[pmid22483426-1] 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.

[pmid16724203-2] 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.

[pmid18244999-3] 3.0 ^3.1 Jenkins JT, O'Dwyer PJ (2008). "Inguinal hernias". BMJ. 336 (7638): 269–72. doi:10.1136/bmj.39450.428275.AD. PMC 2223000. PMID 18244999.

[pmid26987468-4] Berger D (2016). "Evidence-Based Hernia Treatment in Adults". Dtsch Arztebl Int. 113 (9): 150–7, quiz 158. doi:10.3238/arztebl.2016.0150. PMC 4802357. PMID 26987468.

[pmid269874682-5] Berger D (2016). "Evidence-Based Hernia Treatment in Adults". Dtsch Arztebl Int. 113 (9): 150–7, quiz 158. doi:10.3238/arztebl.2016.0150. PMC 4802357. PMID 26987468.

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 [[Leukocytosis]]
-| style="background: #F5F5F5; padding: 5px;" |
+| style="background: #F5F5F5; padding: 5px;" |Enlarged (>17 mm) [[epididymis]] with a hypoechoic, hyperechoic, or [[heterogeneous]] echotexture, increased blood flow
 | style="background: #F5F5F5; padding: 5px;" |[[Hydrocele]]
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+| -
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 | style="background: #F5F5F5; padding: 5px;" |Blood in semen
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-| style="background: #F5F5F5; padding: 5px;" |_
+| style="background: #F5F5F5; padding: 5px;" | -
 | style="background: #F5F5F5; padding: 5px;" |Normal
 | style="background: #F5F5F5; padding: 5px;" |Absent or decreased arterial perfusion of the testis
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 | 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;" |Normal
 | style="background: #F5F5F5; padding: 5px;" |Absent or decreased arterial perfusion of the testis
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 |Unilateral or bilateral
 |Sudden
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 !Diseases
 !Unilateral /Bilateral swelling
-!Lab 3
+!Onset
 ! colspan="1" rowspan="1" |Fever
 !Urinary symptoms
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 | style="background: #F5F5F5; padding: 5px;" |
-| style="background: #F5F5F5; padding: 5px;" | -
+| style="background: #F5F5F5; padding: 5px;" | ±
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 |[[Hydrocele]]
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+|[[Ultrasound|Ultrasound:]]
+simple fluid collection
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 |[[Varicocele]]
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+|Local warmth
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 |
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+|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]]
 |
 |-
 |[[Spermatocele]]
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+|Gradual
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+* Falling snow, resulting from internal echoes moving away from the transducer
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+hypoechoic with posterior acoustic enhancement
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+posterior acoustic enhancement, well defined anechoic lesions, larger cysts may contain septations
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Scrotal mass differential diagnosis: Difference between revisions

Revision as of 18:28, 23 January 2019

Overview

Differential Diagnosis

References

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