Nonacute scrotal conditions in adults and scrotal disorders in. Have a very low threshold for suspecting testicular torsion in a boy or man presenting with acute, painful scrotal swelling. This presentation should always be treated as an emergency because of the possibility of testicular torsion and permanent ischemic damage to the testis. A groin swelling is always considered to be synonymous with a hernia. Most common cause of painless scrotal swelling in children secondary to persistent processus vaginalis. One study evaluated the apneahypopnea index in patients with obstructive sleep apnea and found that even when adjusted for age, body mass index, and the presence of hypertension and diabetes mellitus. Scrotal swellings synopsis of differential diagnosis part.
Torsion testis differential diagnosis epididymo orchitis incarcerated hernia idiopathic scrotal edema torsion of testicular appendages hydrocele p i m s 22. For 74 of these patients, the diagnosis was cancer, based on. The peculiar anatomical conformation of the parts, the varied morbid alterations of structures normally located, andthe frequent intrusion within the scrotal pouch of dislocated or adventitious tissue renders a positive diagnosis difficult, if not indeed impossible in. He had also gained 5 kg over the preceding 2 months. A concerted endeavor in this direction has been made to appraise the audience with their nomenclature origin, clinical variants, presentation and. Other causes of scrotal swelling acute idiopathic scrotal edema is a rare disease that can cause acute scrotal swelling and erythema in boys and is usually painless. Epididymitis differential diagnoses medscape reference. Recognizing these lesions and making the diagnosis can enhance the efficacy of any practicing clinician. Acute scrotal pain is not a rare emergency department.
Scrotal swelling can occur due to injury or an underlying medical condition. A careful assessment of the patient is essential in diagnosis and management box 1. Differential diagnosis of the acute scrotum in the. What is the differential diagnosis of scrotal swelling. Males with a scrotal disorder often present to urgent care with pain, swelling, or both. Differential diagnosis and management of the acute scrotum. Epididymitis must be differentiated from testicular torsion, which is a true urologic emergency. A previously healthy 40yearold man was referred by a urologist to our internal medicine clinic for evaluation of a 6week history of painless scrotal swelling and subsequent ankle swelling.
Pdf scrotal swellings enshrine clinical conditions affecting dermis and or subcutaneous tissue, and those of scrotal contents. It is an important condition to recognize in order to avoid unnecessary surgical exploration. It requires immediate referral to a paediatric surgeon or local surgeon depending on services available. Scrotal swellings enshrine clinical conditions affecting dermis and or subcutaneous tissue, and those of scrotal contents. Torsion of the appendix testicle or appendix epididymis torsion of the spermatic cord idiopathic scrotal edema forniers gangrene testicular tumorcancer henoch schonlein purpura. The differential diagnosis of scrotal swelling includes.
A scrotal lump is an abnormal mass or swelling within the scrotum. Although considered a diagnosis of exclusion, obstructive sleep apnea has been shown to cause edema. Initial investigation of a swelling may include an ultrasound scan, which has a. Inguinoscrotal swellings a problem oriented approach. Scrotal swelling in children american academy of pediatrics. Scrotal swelling in the neonate pubmed central pmc. Discovery of scrotal swelling in a neonate can be a source of anxiety for parents, clinicians, and sonologists alike. Often times, the differential considerations include infection versus torsion in the absence of trauma. Synopsis of differential diagnosis part iii scrotal swellings enshrine clinical conditions affecting dermis and or subcutaneous tissue, and those of scrotal contents. Examination of the patient can also often elucidate the cause of the scrotal mass box 2. Initial investigation of a swelling may include an ultrasound scan, which has a high sensitivity and. The presentation covers a wide range of pathology, therefore a good understanding of the differentiating features can aid in diagnosis, planning of suitable investigations, and the subsequent management.
Diagnosis and treatment of benign scrotal swellings. It may be caused by a buildup of fluid, inflammation, or an abnormal growth within the scrotum. Diagnosis and management american family physician. The differential diagnoses of asymptomatic scrotal swelling include.
Differential diagnosis of a scrotal mass request pdf. The diagnosis begins with taking a medical history and asking about when the swelling started and how painful it is. Pdf scrotal swellings enshrine clinical conditions affecting dermis and or sub cutaneous tissue, and those of scrotal contents. Nonacute scrotal conditions in adults and scrotal disorders in children and adolescents are discussed separately.
Acute scrotal pain requires prompt diagnosis for appropriate treatment. Especially in boys and young men, it is important to quickly assess the acute scrotum, which can be a surgical emergency. What began as mild left scrotal discomfort is now causing increasing pain, swelling, hematuria, dysuria, lowgrade fever, and nausea, prompting him to seek medical attention. Testicular torsion differentials bmj best practice. Surgical exploration is necessary in cases of indefinite differential diagnosis. The differential diagnosis of scrotal tumors is not always an easy matter. The typical presentation involves gradual onset of pain and swelling of the affected side of the scrotum as well as a positive prehn sign. Man, 32, with severe scrotal pain and swelling clinician.
If the swelling is painful, seek emergency treatment. Normally the testicle has a vertical lie within the tunica vaginalis of the scrotum that is. Differential diagnosis includes scrotal trauma, which may also present with epididymal enlargement and hyperemia. Scrotal pain in a young man american urological association. A physical examination will include an examination of the belly, the scrotum.
Scrotal swellings synopsis of differential diagnosis part iii. Torsion should be in the differential for any sudden acute scrotal pain or swelling. These fluid collections may represent persistent developmental connections along the spermatic cord or an imbalance of fluid production versus absorption. Diagnosis for scrotal swellings how do i identify the cause in a boy or man with a scrotal swelling. Assessment and management of scrotal disorders journal. Its exact cause is unclear, but it may have an allergic origin. Torsion testisdoppler study central testicular blood flow normal testis no central testicular blood flow but excessive peripheral blood flow p i m s 23. This guideline has been adapted for statewide use with the support of the victorian paediatric clinical network. The classic physical examination findings with testis torsion are an exquisitely tender testicle with a high, horizontal lie. The general principles of the treatment of edema in adults, including the use of diuretics to remove the excess fluid, the treatment of refractory edema, and the approach to edema. The differential diagnosis of scrotal swelling includes testicular torsion, orchitis secondary to nonsexually transmitted pathogens, hydrocele, spermatocele, and.
Painful scrotum, tender testis epididymitis orchitis testicular torsion trauma e. Emergency ultrasound in acute scrotum emergency evaluation of patients presenting with acute scrotum using bedside ultrasonography michael blaivas, md, paul sierzenski, md, michael lambert,md abstract. A clear cut insight into their symptoms and signs are imperative to comprehend before arriving at their precise diagnosis. Mr imaging in the differential diagnosis of scrotal and. A 32yearold man presents to the urgent care center at a community hospital with severe scrotal pain and swelling of five days duration. Epididymitis is an inflammation of the epididymis that is commonly associated with genitourinary tract infections. Pain, the dependent nature of the scrotum, and the edema and skin changes that accompany many scrotal pathologies may prevent a complete examination. Edema affecting the penis and scrotum mdedge dermatology. Awareness of the diferential diagnosis is therefore essential for aproper diagnosis thus preventing mismanagement. Acute idiopathic scrotal edema radiology reference. A man with painless scrotal swelling and peripheral edema. The term acute scrotum refers to acute scrotal pain with or without swelling and erythema. Hydrocele differential diagnoses medscape reference.
The differential diagnosis of an acute scrotum includes spermatic cord torsion, torsion of. Urology textbook signs and symptoms scrotal swelling. Differential diagnosis of neck swellings very important to differentiate between both types, because each has a different management both are deep to the fascia, so their consistency is similar firm diagnosed by us. Scrotal swelling differential diagnosis scrotal swelling with pain. Scrotal enlargement is seen with some frequency in children and adolescents. There are a number of lesions in the differential diagnosis whose import varies from mundane to lifethreatening.
They can originate from either testicular or extra testicular sources. Ultrasound is the modality of choice for evaluating the scrotum. Asymptomatic scrotal swelling royal college of surgeons. Epididymitis knowledge for medical students and physicians. Differential diagnosis of a scrotal mass wiley online library.
Evaluation of scrotal masses american family physician. Patients with scrotal swelling accompanied by scrotal pain have indications of scrotoscopic exploration, especially when there are difficulties in differential diagnosis of testicular torsion. Table 531 lists the differential diagnoses for the acute scrotum. Predominant pathogenschlamydia trachomatis, gut bacteria usually. Epididymitis is a clinical diagnosis, but testicular torsion should be excluded by ultrasound because it has a similar presentation and is a. For evaluation of the diagnostic potential of magnetic resonance mr imaging in scrotal disease, 200 patients with testicular abnormalities were studied.
Neonates with extravaginal torsion present with scrotal swelling, discoloration, and a firm, painless mass in the scrotum fig. He described no dyspnea, fever, night sweats, dysuria. Scrotal pain, in both its acute and chronic forms, is a diagnostic challenge that must be carefully evaluated with a full patient history and physical examination. Any scrotal swelling needs to be examined by your childs doctor. Acute scrotum is defined as an acute painful swelling of the scrotum or its. Scrotal masses must be differentiated from other diseases that cause scrotal swelling, scrotal pain,such as testicular tortion,epididimitis, testicular tumors,inguinal herniation and many other diseases. When color doppler ultrasound reveals irregular and centrally hypodense accumulation of fluid in the cavity of the tunica vaginalis, the patient also has. This topic addresses the clinical evaluation and management of the acute scrotum, which is defined as moderate to severe scrotal pain that develops over the course of minutes to one to two days, in adults. It is recommended that scrotal ultrasound is used in the acutely painful scrotum where a confident diagnosis cannot be made or there is failure to respond to treatment, and in the chronic swelling. Scrotal swellings enshrine clinical conditions affecting dermis and or sub cutaneous tissue, and those of scrotal contents. In this age group, the diagnosis is often delayed or missed due to a low suspicion because of age.
495 1502 943 875 1271 143 249 1640 518 324 228 1273 442 793 228 970 1028 942 806 650 1350 1055 1451 380 819 1568 391 742 903 209 1498 631 1372 757