Scrotal masses

A mass in the scrotum can be in the contents of the scrotum, the wall, or the scrotum itself. All scrotal masses should be evaluated via surgical investigation. Scrotal masses are separated into two categories: Painful and nonpainful masses.

Torsion is painful and may require surgical intervention. Scrotal swelling that does not contain a mass is most likely associated with a different medical condition such as heart failure or edema.

ALL INTRATESTICULAR MASSES ARE CONSIDERED CANCER UNLESS PROVEN OTHERWISE

Differential Diagnosis
In alphabetical order.

Painful

 * Blunt trauma
 * Cavernous lymphangioma torsion
 * Cysticercosis
 * Dermoid cyst (children)
 * Epididymitis
 * Hematocele
 * Hydrocele
 * Orchitis
 * Scrotal abscess
 * Spermatocele torsion
 * Testicular torsion
 * Testicular appendage torsion

Non-painful

 * Epididymal cyst
 * Hydrocele
 * Scrotal hernia
 * Scrotal swelling
 * Spermatocele
 * Sperm granuloma
 * Strangulated hernia
 * Testicular Cancer
 * Varicocele

Medical History

 * Onset & duration of symptoms
 * Trauma
 * Past/family history
 * Sexual history

Symptoms

 * fever
 * weight loss
 * pain
 * enlarged lymph nodes

Testicles

 * Compare the size, tenderness and position
 * Palpatate spermatic cord
 * Transilluminate areas that could potentially contain a mass
 * Explore cords and canals for hernia, tenderness etc.
 * Digital rectal exam

Epididymitis
In patients with epididymitis, the pain will be relieved upon lifting the testicle above the symphysis pubis.

Laboratory Findings

 * Labs include:
 * CBC
 * urethral gram
 * urinalysis
 * urethral culture

Chest X Ray

 * Required if solid mass is found

MRI and CT

 * Abdominal CT if solid mass is found

Echocardiography or Ultrasound

 * Ultrasound should be performed on all patients
 * Doppler if suspicion of torsion

Other Diagnostic Studies

 * If solid mass found consider serum tumor markers, LDH, electrolytes, BUN / creatinine
 * Urology consult

Torsion

 * Considered an emergency
 * Penetrate spermatic cord with 10-20mL 1% lidocaine and gently twist testicles to the left and right.
 * Relief should be evident immediately upon relief of torsion
 * Surgery is indicated if unsuccessful

Epididymitis

 * Treat with antibiotics and analgesics

Orchitis

 * Treat with antibiotics and analgesics