Scrotal Lumps Flashcards
What are the key causes of scrotal lumps?
Hydrocele
Varicocele
Epididymal cyst
Testicular cancer
Epididymo-orchitis
Inguinal hernia
Testicular torsion
What is a hydrocele?
Collection of serous fluid within the cavity layer of the tunica vaginalis
Painless
Soft-scrotal swelling
During foetal development how does the tunica vaginalis form?
Part of the peritoneal membrane, it becomes separated and remains in the scrotum partially covering each testicle
What are the examination findings of a hydrocele?
Palpable testicle within the hydrocele
Soft, fluctuant and large
Irreducible
Transilluminates
Why may you listen to a suspected hydrocele?
No bowel sounds, helps to distinguish from a hernia
Hydroceles are idiopathic but can be secondary to what?
Testicular cancer
Testicular torsion
Epididymo-orchitis
Trauma
How does a varicocele lead to impaired fertility?
Disrupts the temperature in the affected testicle
Testicular atrophy, leading to reduced size and function
Why do most varicoceles occur on the left?
Left testicular vein is more vertical
Nutcracker effect of the left renal vein between the aorta and IMA
What can left-sided varicoceles also indicate?
Testicular vein obstruction due to renal cell carcinoma
How do varicoceles present?
Throbbing/dull pain, worse on standing
Dragging sensation
Sub-fertility or infertility
What are the examination findings of a varicocele?
Scrotal mass “bag of worms”
More prominent on standing
Disappears when laying down
Asymmetrical testicular size if varicocele has affected testicular growth
Why is it concerning if a varicocele does not disappear when laying down?
May be due to retroperitoneal tumours obstructing drainage of the renal vein
What investigations should be used for varicoceles?
Duplex
Semen analysis (fertility concern)
Hormonal tests
What is the difference between an epididymal cyst and a spermatocele?
Epididymal cyst
Fluid-filled sac at head of the epididymis
Spermatocele
Epididymal cyst that contains sperm
What are the examination findings of an epididymal cyst?
Soft, round lump
Typically at the top of the testicle
Associated with epididymis
Separate from testicle
May be able to transilluminate large cysts
