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: Sujit Routray, M.D. [2]
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.[1] Testicular torsion is primrily diagnosed base on the clinical presentation.
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.[1]
- The evaluation of scrotal mass is as follows:[1]
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.[2]
References
- ↑ 1.0 1.1 1.2 Scrotal mass. American Academy of Family Physicians 2016. http://www.aafp.org/afp/2008/1115/p1165.html. Accessed on March 18, 2016
- ↑ Evaluation of scrotal mass. American academy of family physicians 2016. http://www.aafp.org/afp/2008/1115/p1165.html. Accessed on March 22, 2016