Scrotal mass differential diagnosis: Difference between revisions
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|[[Fourniers gangrene|Fournier's gangrene]] | |[[Fourniers gangrene|Fournier's gangrene]] | ||
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| style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Hydrocele]]<ref name="pmid174600034">{{cite journal |vauthors=Yang DM, Kim HC, Lim JW, Jin W, Ryu CW, Kim GY, Cho H |title=Sonographic findings of groin masses |journal=J Ultrasound Med |volume=26 |issue=5 |pages=605–14 |year=2007 |pmid=17460003 |doi= |url=}}</ref> | | style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Hydrocele]]<ref name="pmid174600034">{{cite journal |vauthors=Yang DM, Kim HC, Lim JW, Jin W, Ryu CW, Kim GY, Cho H |title=Sonographic findings of groin masses |journal=J Ultrasound Med |volume=26 |issue=5 |pages=605–14 |year=2007 |pmid=17460003 |doi= |url=}}</ref> | ||
| style="background: #F5F5F5; padding: 5px; text-align: center;"| | | style="background: #F5F5F5; padding: 5px; text-align: center;" | | ||
| style="background: #F5F5F5; padding: 5px; text-align: left;"|Gradual | | style="background: #F5F5F5; padding: 5px; text-align: left;" |Gradual | ||
| style="background: #F5F5F5; padding: 5px; text-align: center;"| - | | style="background: #F5F5F5; padding: 5px; text-align: center;" | - | ||
| style="background: #F5F5F5; padding: 5px; text-align: center;"|Absent | | style="background: #F5F5F5; padding: 5px; text-align: center;" |Absent | ||
| style="background: #F5F5F5; padding: 5px; text-align: center;"|<nowiki>-</nowiki> | | style="background: #F5F5F5; padding: 5px; text-align: center;" |<nowiki>-</nowiki> | ||
| style="background: #F5F5F5; padding: 5px; text-align: center;"|<nowiki>-</nowiki> | | style="background: #F5F5F5; padding: 5px; text-align: center;" |<nowiki>-</nowiki> | ||
| style="background: #F5F5F5; padding: 5px; text-align: center;"|<nowiki>-</nowiki> | | style="background: #F5F5F5; padding: 5px; text-align: center;" |<nowiki>-</nowiki> | ||
| style="background: #F5F5F5; padding: 5px; text-align: left;"|Absent | | style="background: #F5F5F5; padding: 5px; text-align: left;" |Absent | ||
| style="background: #F5F5F5; padding: 5px; text-align: center;"| + | | style="background: #F5F5F5; padding: 5px; text-align: center;" | + | ||
| style="background: #F5F5F5; padding: 5px; text-align: center;"| | | style="background: #F5F5F5; padding: 5px; text-align: center;" | | ||
| style="background: #F5F5F5; padding: 5px; text-align: center;"| | | style="background: #F5F5F5; padding: 5px; text-align: center;" | | ||
| style="background: #F5F5F5; padding: 5px; text-align: center;"| | | style="background: #F5F5F5; padding: 5px; text-align: center;" | | ||
| style="background: #F5F5F5; padding: 5px; text-align: center;"| | | style="background: #F5F5F5; padding: 5px; text-align: center;" | | ||
| style="background: #F5F5F5; padding: 5px; text-align: left;"|[[Ultrasound|Ultrasound:]] | | style="background: #F5F5F5; padding: 5px; text-align: left;" |[[Ultrasound|Ultrasound:]] | ||
simple fluid collection | simple fluid collection | ||
| style="background: #F5F5F5; padding: 5px; text-align: left;"|Transillumination test +ve. | | style="background: #F5F5F5; padding: 5px; text-align: left;" |Transillumination test +ve. | ||
|- | |- | ||
| style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Varicocele]]<ref name="pmid174600033">{{cite journal |vauthors=Yang DM, Kim HC, Lim JW, Jin W, Ryu CW, Kim GY, Cho H |title=Sonographic findings of groin masses |journal=J Ultrasound Med |volume=26 |issue=5 |pages=605–14 |year=2007 |pmid=17460003 |doi= |url=}}</ref> | | style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Varicocele]]<ref name="pmid174600033">{{cite journal |vauthors=Yang DM, Kim HC, Lim JW, Jin W, Ryu CW, Kim GY, Cho H |title=Sonographic findings of groin masses |journal=J Ultrasound Med |volume=26 |issue=5 |pages=605–14 |year=2007 |pmid=17460003 |doi= |url=}}</ref> | ||
| style="background: #F5F5F5; padding: 5px; text-align: left;"|Unilateral | | style="background: #F5F5F5; padding: 5px; text-align: left;" |Unilateral | ||
(Mainly left) | (Mainly left) | ||
| style="background: #F5F5F5; padding: 5px; text-align: left;"|Gradual | | style="background: #F5F5F5; padding: 5px; text-align: left;" |Gradual | ||
| style="background: #F5F5F5; padding: 5px; text-align: left;"|Local warmth | | style="background: #F5F5F5; padding: 5px; text-align: left;" |Local warmth | ||
| style="background: #F5F5F5; padding: 5px; text-align: left;"|Absent | | style="background: #F5F5F5; padding: 5px; text-align: left;" |Absent | ||
| style="background: #F5F5F5; padding: 5px; text-align: center;"|<nowiki>-</nowiki> | | style="background: #F5F5F5; padding: 5px; text-align: center;" |<nowiki>-</nowiki> | ||
| style="background: #F5F5F5; padding: 5px; text-align: center;"|± | | style="background: #F5F5F5; padding: 5px; text-align: center;" |± | ||
| style="background: #F5F5F5; padding: 5px; text-align: center;"|<nowiki>-</nowiki> | | style="background: #F5F5F5; padding: 5px; text-align: center;" |<nowiki>-</nowiki> | ||
| style="background: #F5F5F5; padding: 5px; text-align: left;"|Absent | | style="background: #F5F5F5; padding: 5px; text-align: left;" |Absent | ||
| style="background: #F5F5F5; padding: 5px; text-align: center;"| + | | style="background: #F5F5F5; padding: 5px; text-align: center;" | + | ||
| style="background: #F5F5F5; padding: 5px; text-align: center;"| | | style="background: #F5F5F5; padding: 5px; text-align: center;" | | ||
| style="background: #F5F5F5; padding: 5px; text-align: center;"| | | style="background: #F5F5F5; padding: 5px; text-align: center;" | | ||
| style="background: #F5F5F5; padding: 5px; text-align: center;"| | | style="background: #F5F5F5; padding: 5px; text-align: center;" | | ||
* [[Renal cancer]] | * [[Renal cancer]] | ||
* [[Nephrectomy]] | * [[Nephrectomy]] | ||
* Nut-cracker syndrome | * Nut-cracker syndrome | ||
|style="background: #F5F5F5; padding: 5px; text-align: left;"| style="background: #F5F5F5; padding: 5px; text-align: left;"| | | style="background: #F5F5F5; padding: 5px; text-align: left;" |<nowiki> style="background: #F5F5F5; padding: 5px; text-align: left;"|</nowiki> | ||
|style="background: #F5F5F5; padding: 5px; text-align: left;"|[[Ultrasonography:]] | | style="background: #F5F5F5; padding: 5px; text-align: left;" |[[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]] | [[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]] | ||
|style="background: #F5F5F5; padding: 5px; text-align: left;"| | | style="background: #F5F5F5; padding: 5px; text-align: left;" | | ||
|style="background: #F5F5F5; padding: 5px; text-align: center;"|- | | style="background: #F5F5F5; padding: 5px; text-align: center;" | - | ||
| style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Spermatocele]]<ref name="pmid174600032">{{cite journal |vauthors=Yang DM, Kim HC, Lim JW, Jin W, Ryu CW, Kim GY, Cho H |title=Sonographic findings of groin masses |journal=J Ultrasound Med |volume=26 |issue=5 |pages=605–14 |year=2007 |pmid=17460003 |doi= |url=}}</ref> | | style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Spermatocele]]<ref name="pmid174600032">{{cite journal |vauthors=Yang DM, Kim HC, Lim JW, Jin W, Ryu CW, Kim GY, Cho H |title=Sonographic findings of groin masses |journal=J Ultrasound Med |volume=26 |issue=5 |pages=605–14 |year=2007 |pmid=17460003 |doi= |url=}}</ref> | ||
|style="background: #F5F5F5; padding: 5px; text-align: left;"| | | style="background: #F5F5F5; padding: 5px; text-align: left;" | | ||
|style="background: #F5F5F5; padding: 5px; text-align: left;"|Gradual | | style="background: #F5F5F5; padding: 5px; text-align: left;" |Gradual | ||
|style="background: #F5F5F5; padding: 5px; text-align: left;"| | | style="background: #F5F5F5; padding: 5px; text-align: left;" | | ||
|style="background: #F5F5F5; padding: 5px; text-align: left;"| | | style="background: #F5F5F5; padding: 5px; text-align: left;" | | ||
|style="background: #F5F5F5; padding: 5px; text-align: left;"|<nowiki>-</nowiki> | | style="background: #F5F5F5; padding: 5px; text-align: left;" |<nowiki>-</nowiki> | ||
|style="background: #F5F5F5; padding: 5px; text-align: left;"|<nowiki>-</nowiki> | | style="background: #F5F5F5; padding: 5px; text-align: left;" |<nowiki>-</nowiki> | ||
|style="background: #F5F5F5; padding: 5px; text-align: left;"|<nowiki>-</nowiki> | | style="background: #F5F5F5; padding: 5px; text-align: left;" |<nowiki>-</nowiki> | ||
|style="background: #F5F5F5; padding: 5px; text-align: left;"|Absent | | style="background: #F5F5F5; padding: 5px; text-align: left;" |Absent | ||
|style="background: #F5F5F5; padding: 5px; text-align: center;"| + | | style="background: #F5F5F5; padding: 5px; text-align: center;" | + | ||
|style="background: #F5F5F5; padding: 5px; text-align: left;"| | | style="background: #F5F5F5; padding: 5px; text-align: left;" | | ||
|style="background: #F5F5F5; padding: 5px; text-align: left;"| | | style="background: #F5F5F5; padding: 5px; text-align: left;" | | ||
* Falling snow, resulting from internal echoes moving away from the transducer | * Falling snow, resulting from internal echoes moving away from the transducer | ||
|style="background: #F5F5F5; padding: 5px; text-align: left;"| | | style="background: #F5F5F5; padding: 5px; text-align: left;" | | ||
|style="background: #F5F5F5; padding: 5px; text-align: left;"| | | style="background: #F5F5F5; padding: 5px; text-align: left;" | | ||
|style="background: #F5F5F5; padding: 5px; text-align: left;"|[[Ultrasonography]]: | | style="background: #F5F5F5; padding: 5px; text-align: left;" |[[Ultrasonography]]: | ||
hypoechoic with posterior acoustic enhancement | hypoechoic with posterior acoustic enhancement | ||
|style="background: #F5F5F5; padding: 5px; text-align: left;"| | | style="background: #F5F5F5; padding: 5px; text-align: left;" | | ||
|- | |- | ||
| style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Inguinal hernia|Inguino-scrotal hernia]]<ref name="pmid269874682">{{cite journal |vauthors=Berger D |title=Evidence-Based Hernia Treatment in Adults |journal=Dtsch Arztebl Int |volume=113 |issue=9 |pages=150–7; quiz 158 |year=2016 |pmid=26987468 |pmc=4802357 |doi=10.3238/arztebl.2016.0150 |url=}}</ref><ref name="pmid18244999" /> | | style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Inguinal hernia|Inguino-scrotal hernia]]<ref name="pmid269874682">{{cite journal |vauthors=Berger D |title=Evidence-Based Hernia Treatment in Adults |journal=Dtsch Arztebl Int |volume=113 |issue=9 |pages=150–7; quiz 158 |year=2016 |pmid=26987468 |pmc=4802357 |doi=10.3238/arztebl.2016.0150 |url=}}</ref><ref name="pmid18244999" /> | ||
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| style="background: #DCDCDC; padding: 5px; text-align: center;" |Scrotal | | style="background: #DCDCDC; padding: 5px; text-align: center;" |Scrotal eodema | ||
|Bilateral and can extend to perineum | |Bilateral and can extend to perineum | ||
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|Occurs between 4-12 years of age. | |Occurs between 4-12 years of age. | ||
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|style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Epididymal cyst]]<ref name="pmid17460003">{{cite journal |vauthors=Yang DM, Kim HC, Lim JW, Jin W, Ryu CW, Kim GY, Cho H |title=Sonographic findings of groin masses |journal=J Ultrasound Med |volume=26 |issue=5 |pages=605–14 |year=2007 |pmid=17460003 |doi= |url=}}</ref> | | style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Epididymal cyst]]<ref name="pmid17460003">{{cite journal |vauthors=Yang DM, Kim HC, Lim JW, Jin W, Ryu CW, Kim GY, Cho H |title=Sonographic findings of groin masses |journal=J Ultrasound Med |volume=26 |issue=5 |pages=605–14 |year=2007 |pmid=17460003 |doi= |url=}}</ref> | ||
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|Ultrasonography: | |Ultrasonography: | ||
posterior acoustic enhancement, well defined anechoic lesions, larger cysts may contain septations | posterior acoustic enhancement, well defined anechoic lesions, larger cysts may contain septations | ||
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|style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Congenital cystic dysplasia|Cystic dysplasia]] | | style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Congenital cystic dysplasia|Cystic dysplasia]] | ||
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Revision as of 14:42, 28 January 2019
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Scrotal Mass Microchapters |
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Diagnosis |
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Treatment |
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Case Studies |
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Scrotal mass differential diagnosis On the Web |
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American Roentgen Ray Society Images of Scrotal mass differential diagnosis |
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Risk calculators and risk factors for Scrotal mass differential diagnosis |
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 | Blood/Urine Analysis | Doppler U/S | ||||||||||||||||||||||||||||||||||||||||
| Epididymitis[1] | Unilateral | Gradual | ± | Dysuria, frequency, and/or urgency | + | - | Pyuria | Painful local lymphadenopathy | + | Leukocytosis | Enlarged (>17 mm) epididymis with a hypoechoic, hyperechoic, or heterogeneous echotexture, increased blood flow |
|
|
Phen sign +ve | ||||||||||||||||||||||||||||||||||||
| Orchitis
(Mumps) |
Bilateral | Abrupt | ± | Dysuria | + | - | ± | Painful local lymphadenopathy | + | Leukocytosis |
|
|
Phen sign +ve | |||||||||||||||||||||||||||||||||||||
| Testicular Torsion[2] | Unilateral | Sudden | - | + | + | Blood in semen may be present | Absent | - | Normal | Absent or decreased arterial perfusion of the testis |
|
Phen sign +ve | ||||||||||||||||||||||||||||||||||||||
| Hematocele | Unilateral or bilateral | Sudden | - | + | + | Blood in semen | Absent |
|
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| Incarcerated Hernia[3][4] | Unilateral | Sudden | + | Absent | + | + | - | Absent | - | 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 | Blood/Urine Analysis | Doppler U/S | Past Medical History | Histopathology | Gold standard | Additional findings | ||||||||||||||||||||||||||||||||||
| Painless | Fragile XMacroorchidism | Bilateral | - | + | ||||||||||||||||||||||||||||||||||||||||||||||
| Testicular Tumors | ± | + | ||||||||||||||||||||||||||||||||||||||||||||||||
| Henoch-Schonlein purpura | - | - | ||||||||||||||||||||||||||||||||||||||||||||||||
| Hydrocele[5] | Gradual | - | Absent | - | - | - | Absent | + | Ultrasound:
simple fluid collection |
Transillumination test +ve. | ||||||||||||||||||||||||||||||||||||||||
| Varicocele[6] | Unilateral
(Mainly left) |
Gradual | Local warmth | Absent | - | ± | - | Absent | + |
|
style="background: #F5F5F5; padding: 5px; text-align: left;"| | 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[7] | Gradual | - | - | - | Absent | + |
|
Ultrasonography:
hypoechoic with posterior acoustic enhancement |
||||||||||||||||||||||||||||
| Inguino-scrotal hernia[8][3] | - | - | Absent | |||||||||||||||||||||||||||||||||||||||||||||||
| Scrotal eodema | Bilateral and can extend to perineum | - | - | - | Eosinophilia | Occurs between 4-12 years of age. | ||||||||||||||||||||||||||||||||||||||||||||
| Epididymal cyst[9] | ± | Ultrasonography:
posterior acoustic enhancement, well defined anechoic lesions, larger cysts may contain septations |
||||||||||||||||||||||||||||||||||||||||||||||||
| Sebaceous cyst | ||||||||||||||||||||||||||||||||||||||||||||||||||
| Carcinoma of the scrotum | ||||||||||||||||||||||||||||||||||||||||||||||||||
| Chylocele (Filariasis) | Gradually/Rapidly | |||||||||||||||||||||||||||||||||||||||||||||||||
| 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.
- ↑ Yang DM, Kim HC, Lim JW, Jin W, Ryu CW, Kim GY, Cho H (2007). "Sonographic findings of groin masses". J Ultrasound Med. 26 (5): 605–14. PMID 17460003.
- ↑ Yang DM, Kim HC, Lim JW, Jin W, Ryu CW, Kim GY, Cho H (2007). "Sonographic findings of groin masses". J Ultrasound Med. 26 (5): 605–14. PMID 17460003.
- ↑ Yang DM, Kim HC, Lim JW, Jin W, Ryu CW, Kim GY, Cho H (2007). "Sonographic findings of groin masses". J Ultrasound Med. 26 (5): 605–14. PMID 17460003.
- ↑ 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.
- ↑ Yang DM, Kim HC, Lim JW, Jin W, Ryu CW, Kim GY, Cho H (2007). "Sonographic findings of groin masses". J Ultrasound Med. 26 (5): 605–14. PMID 17460003.