Scrotal mass physical examination
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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
Common physical examination findings of scrotal mass include swelling and tender mass which is having a smooth, twisted, or irregular shape and liquid, firm, or solid in consistency. The ipsilateral inguinal lymph nodes may be enlarged or tender. physical examination of scrotal masses depends on causes.common physical examinations in testicular tortion is an elevated ,horizontlly aligned testicle. Also they have severe tenderness and firm in palpation.Cremastic reflex and phren sign are absent.In testicular apendix tortion ,phathognomonic sign is Blue dot,which is a nodule with blue discoloration.In hydrocele transillumination test will be positive.
Physical Evaluation
The physical examination findings of scrotal mass depend on the cause of the mass. The likely diagnoses of a scrotal mass based on physical examination findings include:[1]
Swelling of the Testis
Swelling of the testis | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Tender, onset <24 hours | Nontender, gradual onset | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Torsion versus orchitis | Solid | Transilluminates | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Emergent surgical referral | Suspect testicular cancer; order sonography or refer | Hydrocele obscuring testis; order sonography to confirm | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Adapted from American academy of family physicians.[1]
Swelling of the Epididymis
Swelling of the epididymis | |||||||||||||||||||||||||||||||||||||||||||||||||||||||
Diffusely swollen, tender, acute onset | Nodule, stable in size | ||||||||||||||||||||||||||||||||||||||||||||||||||||||
Epididymitis | Spermatocele; sonography to confirm | ||||||||||||||||||||||||||||||||||||||||||||||||||||||
Adapted from American academy of family physicians.[1]
Swelling of the Spermatic Cord
Swelling of the spermatic cord | |||||||||||||||||||||||||||||||||||||||||||||||||||||||
Swelling extends to inguinal ring | "Bag of worms" texture | Smooth, transilluminates | |||||||||||||||||||||||||||||||||||||||||||||||||||||
Indirect inguinal hernia | Varicocele | Hydrocele | |||||||||||||||||||||||||||||||||||||||||||||||||||||
Adapted from American academy of family physicians.[1]
Swelling of the Skin
Swelling of the skin | |||||||||||||||||||||||||||||||||||||||||||||||||||||
Irregular, enlarging; occupational risk | Smooth, cystic, stable in size | ||||||||||||||||||||||||||||||||||||||||||||||||||||
TRule out squamous cell carcinoma | Sebaceous cyst | ||||||||||||||||||||||||||||||||||||||||||||||||||||
Adapted from American academy of family physicians.[1]
Physical Examination
Physical examination of patients with testicular tortion is usually remarkable for horizontally aligned testicle, absence of cremasteric reflex, and phern sign.
The presence of blu dot sign on physical examination is diagnostic of testicular appendix tortion.
The presence of bag of worms on physical examination is highly suggestive of varicocele.
The presence of transillumination test on physical examination is highly suggestive of hydrocele.
Appearance of the Patient
- Depond on the cause of scrotal mass is different.
- Patients with painfull scrotal usually appear ill and patients without pain usually apear normal.
Vital Signs
- In epididymitis may have low-grade fever
Skin
- Skin examination of patients with scrotal mass is usually normal.
- In epididymitis scrotal skin on the affected side may be erythematous.
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Description (Adapted from Dermatology Atlas)
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Description (Adapted from Dermatology Atlas)
HEENT
- HEENT examination of patients with scrotal mass is usually normal.
OR
- Abnormalities of the head/hair may include ___
- Evidence of trauma
- Icteric sclera
- Nystagmus
- Extra-ocular movements may be abnormal
- Pupils non-reactive to light / non-reactive to accommodation / non-reactive to neither light nor accommodation
- Ophthalmoscopic exam may be abnormal with findings of ___
- Hearing acuity may be reduced
- Weber test may be abnormal (Note: A positive Weber test is considered a normal finding / A negative Weber test is considered an abnormal finding. To avoid confusion, you may write "abnormal Weber test".)
- Rinne test may be positive (Note: A positive Rinne test is considered a normal finding / A negative Rinne test is considered an abnormal finding. To avoid confusion, you may write "abnormal Rinne test".)
- Exudate from the ear canal
- Tenderness upon palpation of the ear pinnae/tragus (anterior to ear canal)
- Inflamed nares / congested nares
- Purulent exudate from the nares
- Facial tenderness
- Erythematous throat with/without tonsillar swelling, exudates, and/or petechiae
Neck
- Neck examination of patients with scrotal mass is usually normal.
- Patients with scrotal cancer with metastesis :
Lungs
- Pulmonary examination of patients with [disease name] is usually normal.
OR
- Asymmetric chest expansion OR decreased chest expansion
- Lungs are hyporesonant OR hyperresonant
- Fine/coarse crackles upon auscultation of the lung bases/apices unilaterally/bilaterally
- Rhonchi
- Vesicular breath sounds OR distant breath sounds
- Expiratory wheezing OR inspiratory wheezing with normal OR delayed expiratory phase
- Wheezing may be present
- Egophony present/absent
- Bronchophony present/absent
- Normal/reduced tactile fremitus
Heart
- Cardiovascular examination of patients with [disease name] is usually normal.
OR
- Chest tenderness upon palpation
- PMI within 2 cm of the sternum (PMI) / Displaced point of maximal impulse (PMI) suggestive of ____
- Heave / thrill
- Friction rub
- S1
- S2
- S3
- S4
- Gallops
- A high/low grade early/late systolic murmur / diastolic murmur best heard at the base/apex/(specific valve region) may be heard using the bell/diaphgram of the stethoscope
Abdomen
- Abdominal examination of patients with [disease name] is usually normal.
OR
- Abdominal distension
- Abdominal tenderness in the right/left upper/lower abdominal quadrant
- Rebound tenderness (positive Blumberg sign)
- A palpable abdominal mass in the right/left upper/lower abdominal quadrant
- Guarding may be present
- Hepatomegaly / splenomegaly / hepatosplenomegaly
- Additional findings, such as obturator test, psoas test, McBurney point test, Murphy test
Back
- Back examination of patients with [disease name] is usually normal.
OR
- Point tenderness over __ vertebrae (e.g. L3-L4)
- Sacral edema
- Costovertebral angle tenderness bilaterally/unilaterally
- Buffalo hump
Genitourinary
- Genitourinary examination of patients with [disease name] is usually normal.
OR
- A pelvic/adnexal mass may be palpated
- Inflamed mucosa
- Clear/(color), foul-smelling/odorless penile/vaginal discharge
Neuromuscular
- Neuromuscular examination of patients with [disease name] is usually normal.
OR
- Patient is usually oriented to persons, place, and time
- Altered mental status
- Glasgow coma scale is ___ / 15
- Clonus may be present
- Hyperreflexia / hyporeflexia / areflexia
- Positive (abnormal) Babinski / plantar reflex unilaterally/bilaterally
- Muscle rigidity
- Proximal/distal muscle weakness unilaterally/bilaterally
- ____ (finding) suggestive of cranial nerve ___ (roman numerical) deficit (e.g. Dilated pupils suggestive of CN III deficit)
- Unilateral/bilateral upper/lower extremity weakness
- Unilateral/bilateral sensory loss in the upper/lower extremity
- Positive straight leg raise test
- Abnormal gait (describe gait: e.g. ataxic (cerebellar) gait / steppage gait / waddling gait / choeiform gait / Parkinsonian gait / sensory gait)
- Positive/negative Trendelenburg sign
- Unilateral/bilateral tremor (describe tremor, e.g. at rest, pill-rolling)
- Normal finger-to-nose test / Dysmetria
- Absent/present dysdiadochokinesia (palm tapping test)
Extremities
- Extremities examination of patients with [disease name] is usually normal.
OR
- Clubbing
- Cyanosis
- Pitting/non-pitting edema of the upper/lower extremities
- Muscle atrophy
- Fasciculations in the upper/lower extremity