Approach to Scrotal Swellings and Pain

Question 1

Physical Examination of the Scrotum

Answer 1

-Inspect-
1. Scars
2. Swelling
3. Testicular Lie

-Palpate-
1. Tender
2. Get above the swelling or confined to scrotum
3. Identification of epididymis and testis, is lump separate or part of them?
4. Palpate normal contour of testes identifying epididymis and ductus deferens
5. If lump present, transilluminable?

-Offer-
1. Transilluminate
2. Groin Examination for Hernia
3. Inguinal Lymphadenopathy

Question 2

Differentials of Scrotal Swelling

Answer 2

• Cannot get above swelling -
  1. Hernia: Cough Impulse, Testis palpable, Opaque
  2. Infantile Hydrocele: No cough impulse, Not reducible, Testis not palpable, Transilluminable
• Can get above swelling -
  – Testis not definable from epididymis –
  —Opaque—
  —Non tender —-
  1. Chronic Hematocele
  2. Gumma
  3. Tumour
  —-Tender—-
  1. Torsion
  2. Epididymo-orchitis
  3. Acute Hematocele
  —Transilluminable—
  1. Hydrocele

–Testis definable from epididymis–
—Opaque—
—-Non-tender swelling of testis—-
1. Tumour
—-Non-tender swelling of epididymis—-
1. TB Epididymis
—-Tender—-
1. Epididymo-orchitis
—Transilluminable—
1. Cyst of Epididymis