Scrotal Mass Flashcards
What questions must you ask about this scrotal mass?
- Is the lump painful?
- How long has lump been there?
- What made the patient first notice the lump?
- Has the lump gotten bigger, smaller or stayed the same size?
- Is the lump always there
- Any other lumps
- Does he have any other symptoms
- Any trauma to the testes
- Do testes feel heavy
What would an acute swollen and tender scrotum suggest?
testicular torsion until proven othersie
Is a testicular malignancy painful?
no
What would a scrotal mass that has been there for hours suggest?
testicular torsion
What could a scrotal mass that has been there weeks/months suggest?
testicular tumour
How would an inguinal hernia change with movement?
can extend to scrotum during exertion or long period of standing (increase in intra-abdominal pressure)
What scrotal mass differential varies in size throughout the day and disappears when lying down?
varicoceles
What other symptoms would you enquire about?
- UTI symptoms
2. STI symptoms
What are common UTI symptoms?
- dysuria
- polyuria
- suprapubic pain
- offensive smelling urine
- urgency
- strangury
- haematuria
What could STI symptoms be?
purulent urethral discharge
Why do you ask if the testes feel heavy?
raise sus of cancer
What are 4 key characteristics to ask about to narrow differential diagnosis scrotal mass?
- Can you get above it? Is swelling confined to scrotum or does it extend proximally into groin?
- Is it possible to palpate the testis seperately from the swelling/lump?
- Does it transilluminate?
- Is the mass tender?
What would an extension of a mass into the groin suggest?
inguinoscrotal hernia
What features should you try to indentify on palpitation?
- spermatic cord
- epidiymis
- testis
- (if you can’t due to the lump, try to see which of remaining structures you can palpate)
Which types of masses glow?
fluid
Which types of masses are opaque?
solid
What would a scrotal mass that you can’t get above suggest?
unguinoscrotal hernia
What would a scrotal mass that you can get above, is separate from the testes and is trasniluminable suggest?
- epididymal cyst
2. acute idiopathic scrotal oedema
What would a scrotal mass that you can get above, is separate from the testes and is not trasniluminable but is tender suggest?
- acute epididymitis
2. torsion of hydatid of morgagni
What would a scrotal mass that you can get above, is separate from the testes and is not trasniluminable and is not tender suggest?
- TB epididymitis
2. Post vasectomy sperm granuloma
What would a scrotal mass that you can get above, is not separate from the testes and is trasniluminable?
hydrocele
What would a scrotal mass that you can get above, is not separate from the testes and is not transiluminable and not tender?
- cancer
- chronic haematocele
- gumma
What would a scrotal mass that you can get above, is not separate from the testes and is not transiluminable and tender?
- torison
- orchitis
- epidymo-orchtis
- acute haematocele
What are two different way testicular tumours can present?
- nodule within the testis
- an ill-defined circumferential swelling
How can a chronic haematocele develop?
develop following an acute bleed - clotted blood within tunica vaginalis contracts and hardens around the testis producing a mass that is clinically indistinguishable from a tumour
What are the risk factors for a testicular tumour?
- history of undescended or maldescended testes
2. history or orchidopexy
Where do testes and scrotal skin drain?
- testes: para-aortic nodes
2. scrotal skin: inguinal nodes
If testicular tumour which nodes should you examine?
para-aortic (but hard to feel)
What are some systemic symptoms of malignancy you should look out for?
- weight loss
- fatigue
- night sweats
- metastasis (resp symptoms, back pain or neurological symptoms)
If testicular tumour found what is next step?
urgent referral to urologist
What does urologist do?
- US scan of both testes
- tumour markers
- staging scans
Why do you look for tumour makers?
- aid diagnosis
- monitoring response to treatment
- monitoring for relapse
What tumour markers may you look for?
- AFP
- Beta HCG
- LDH
