Scrotal Mass Flashcards
Why is accurate diagnosis of scrotal masses important?
Scrotal masses can range from benign to life-threatening conditions, so an accurate diagnosis is essential to determine appropriate management.
What structures are housed within the scrotum?
The scrotum houses the testes, epididymis, spermatic cord, and associated structures.
Why is understanding scrotal anatomy important in evaluating scrotal masses?
It helps in clinically differentiating scrotal masses by identifying the anatomical compartment involved.
What are key historical factors to assess in a patient with a scrotal mass?
Onset: Acute vs. chronic
Pain: Presence, severity, radiation
Swelling: Unilateral or bilateral
Systemic Symptoms: Fever, weight loss, urinary symptoms
Trauma History: Direct injury
Sexual History: Recent STIs or high-risk behavior
Past Medical/Surgical History: Previous surgeries, infections, or malignancies
What should be assessed on inspection of a scrotal mass?
Look for swelling, erythema, skin changes, and the position of the testis.
How do you determine if a scrotal mass is intra- or extratesticular?
Through palpation, assessing where the mass is located relative to the testis.
What features of palpation help differentiate scrotal masses?
Consistency: Soft, firm, or hard
Tenderness: Painful vs. non-painful
Fluctuation & Transillumination: Determines fluid-filled vs. solid mass
Reducibility: Suggests hernia vs. hydrocele
Cough Impulse: Indicates the presence of a hernia
What are the key features of an epididymal cyst (spermatocele)?
Painless, fluctuant mass
Transilluminates
Arises from the epididymis
What is a hydrocele, and how does it present?
A collection of fluid in the tunica vaginalis
Non-tender, transilluminates
What are the characteristic findings of a varicocele?
Dilated pampiniform plexus
“Bag of worms” sensation
Worsens with standing, reduces when lying down
What are the symptoms of orchitis/epididymo-orchitis?
Painful, swollen testicle
Fever, UTI symptoms
Often associated with STIs (gonorrhea, chlamydia) or urinary infections
What are the key clinical features of testicular cancer (seminoma, non-seminomatous germ cell tumors, lymphoma)?
Hard, irregular, non-tender mass
Does not transilluminate
May have systemic signs (weight loss, back pain from retroperitoneal lymph node spread)
How does an inguinal hernia present in the scrotum?
- Soft, reducible mass
- Positive cough impulse
- Can extend into the scrotum
What are the features of a scrotal abscess?
Erythematous, painful, fluctuant mass
Associated with signs of infection
How can you differentiate a sebaceous cyst from other scrotal masses?
Small, superficial, mobile mass
Non-tender
Why is testicular torsion a surgical emergency?
Acute onset of severe pain
High-riding testis
Absent cremasteric reflex
How does a testicular hematoma present?
History of trauma
Painful mass
May not transilluminate
What laboratory tests are useful for evaluating scrotal masses?
CBC (infection, malignancy suspicion)
Urinalysis and urine culture (UTI, STI)
Tumor markers (AFP, β-hCG, LDH) – for testicular cancer
STI screening (if epididymo-orchitis suspected)
What is the gold standard imaging modality for scrotal masses?
Scrotal ultrasound
- Differentiates solid vs. cystic lesions
- Assesses vascularity (Doppler for torsion or varicocele)
When is a CT Abdomen/Pelvis indicated in scrotal masses?
For staging of testicular malignancy
In what situation is exploratory surgery considered for scrotal masses?
If malignancy is suspected
How are epididymal cysts managed?
Observation, surgical excision if symptomatic
When should a hydrocele be surgically drained?
If large or symptomatic
