24. Scrotal Mass Flashcards
What are the main contents of the scrotum?
Testes
Epididymis
Testicular arteries
Pampiniform plexus
What must you immediately consider if the lump is painful?
Testicular torsion
List important features of the history of presenting complaint that you must ask about.
Is the lump painful? How long has the lump been there for? When did you first notice the lump? Has the lump got bigger, smaller or stayed the same size? Is the lump always there? Are there any other lumps? Has there been any trauma to the testes? Does the testis feel heavy?
When do inguinal hernias tend to appear in the scrotum?
When intra-abdominal pressure is increased (e.g. when coughing)
Describe the variation in size of a varicocoele during the day?
They disappear when the patient lies flat
They will appear when the patient has been standing for a long time
List some UTI symptoms that you should ask about.
Dysuria Polyuria Suprapubic pain Offensive-smelling urine Urgency Strangury Haematuria
List an STI symptom that you should ask about.
Urethral discharge
What feature of the testis raises suspicion of testicular cancer?
If the testicle feels heavy
What is the most likely diagnosis if you can’t get above the swelling?
Inguinoscrotal hernia
Why is it important to check whether the mass is separate from the testicle?
It allows you to elicit whether the problem is in the testicle itself, or with other structures within the scrotum
What important information about the swelling does transillumination allow you to elicit?
It tells you whether the swelling is caused by a collection of fluid (e.g. a cyst) or a solid mass (e.g. a tumour)
What would you suspect if the mass is NOT separate from the testis and does transilluminate?
Hydrocoele
What would you suspect if the mass is NOT separate from the testis, does NOT transilluminate and is tender?
Testicular torsion
Orchitis
Epididymo-orchitis
Acute haematocoele
What would you suspect if the mass is NOT separate from the testis, does NOT transilluminate and is NOT tender?
Testicular cancer
Chronic haematocoele
Gumma
What would you suspect if the mass is separate from the testis and does transilluminate?
Epididymal cyst