25. Scrotal Mass

Question 1

What details of a scrotal lump should you find out?

Answer 1

Is it painful?
Acutely swollen and tender scrotum= testicular torsion until proven otherwise
How long has it been there? Testicular torsion will only have been present for hours
What made the patient first notice the lump?
Is the lump always there? Inguinal hernias may extend into the scrotum, varicoceles can vary in size throughout the day

Has there been any trauma to the testes?
Do the testis feel heavy- Testicular cancer (?)

Question 2

What are 4 key characteristics of a scrotal mass that will let you narrow your differential?

Answer 2

Can you get above it? If not- inguinoscrotal hernia
Can you palpate the testis separate from the swelling/ lump?
Does it transilluminate? When you shine a torchlight it will glow full of fluid (hydrocele) but be opaque if it is solid
Is it tender?

Question 3

What would you suspect if the scrotal mass is separate from the testis and transilluminable?

Answer 3

Epididymal cyst

Question 4

What would you suspect if the scrotal mass is separate from the testis, transilluminable and tender?

Answer 4

Acute epididymitis

Question 5

What would you suspect if the scrotal mass is not separate from the testis and transilluminable?

Answer 5

Hydrocele

Question 6

What would you suspect if the scrotal mass is not separate from the testis and not transilluminable and tender/ not tender?

Answer 6

Tender- orchitis, epididymo orchitis, torsion

Non tender- cancer