Scrotal Mass Flashcards
What are the main contents of the scrotum?
Testes
Epididymis
Testicular arteries
Pampiniform plexus
What must you immediately consider if the lump is painful?
Testicular torsion
List important features of the history of presenting complaint that you must ask about.
Is the lump painful? How long has the lump been there for? When did you first notice the lump? Has the lump got bigger, smaller or stayed the same size? Is the lump always there? Are there any other lumps? Has there been any trauma to the testes? Does the testis feel heavy?
When do inguinal hernias tend to appear in the scrotum?
When intra-abdominal pressure is increased (e.g. when coughing)
Describe the variation in size of a varicocoele during the day?
They disappear when the patient lies flat
They will appear when the patient has been standing for a long time
List some UTI symptoms that you should ask about.
Dysuria Polyuria Suprapubic pain Offensive-smelling urine Urgency Strangury Haematuria
List an STI symptom that you should ask about.
Urethral discharge
What feature of the testis raises suspicion of testicular cancer?
If the testicle feels heavy
What is the most likely diagnosis if you can’t get above the swelling?
Inguinoscrotal hernia
Why is it important to check whether the mass is separate from the testicle?
It allows you to elicit whether the problem is in the testicle itself, or with other structures within the scrotum
What important information about the swelling does transillumination allow you to elicit?
It tells you whether the swelling is caused by a collection of fluid (e.g. a cyst) or a solid mass (e.g. a tumour)
What would you suspect if the mass is NOT separate from the testis and does transilluminate and NOT painful?
Hydrocoele
What would you suspect if the mass is part of the testis, does NOT transilluminate and is tender?
Testicular torsion
Orchitis
Epididymo-orchitis
Acute haematocoele
What would you suspect if the mass is NOT separate from the testis, does NOT transilluminate and is NOT tender?
Testicular cancer
Chronic haematocoele
Gumma
What would you suspect if the mass is separate from the testis and does transilluminate?
Epididymal cyst
What would you suspect if the mass is separate from the testis, does NOT transilluminate and is tender?
Acute epididymitis
Torsion of hydatid of Morgagni (appendix testis)
What would you suspect if the mass is separate from the testis, does NOT transilluminate and is NOT tender?
TB epididymitis
Post vasectomy sperm granuloma
What is the main risk factor for testicular cancer?
Undescended/maldescended testicle
What is the term given to the operation that places an undescended testicle in its correct place?
Orchidopexy
To which lymph nodes do the testes drain?
Para-aortic lymph nodes
To which lymph nodes does the scrotum drain?
Inguinal lymph nodes
List some systemic symptoms of malignancy.
Fever
Weight loss
Night sweats
What is the investigation of choice for any scrotal mass?
Ultrasound scan
What are the main tumour markers for testicular cancer?
a-fetoprotein (AFP)
B-HCG
Lactate dehydrogenase (LDH)
Describe the characteristic features of an epididymal cyst.
Distinct from the testis (superior and posterior to it)
Can get above the swelling
Fluctuant and transilluminable
Often multiple or multiocular, and may be bilateral
What is the term given to a subtype of epididymal cyst that contains milky fluid?
Spermatocoele
Describe what a varicocoele feels like on palpation.
It feels like ‘a bag of worms’
What is a varicocoele?
It is made up of dilated, tortuous veins of the pampiniform plexus
How do varicocoeles vary in size?
They respond to changes in venous pressure so they can increase in size towards the end of the day (due to venous pooling) or following strenuous exercise
When the patient lies down, the varicocoele will not be palpable
What conservative measure can be taken to reduce discomfort caused by varicocoeles?
Scrotal support (e.g. jock strap or tighter pants)
If the varicocoele is painful, surgical intervention may be taken. List some treatment options.
Embolisation
Surgical ligation
Sclerotherapy
What is a hydrocele?
A collection of fluid within the tunica vaginalis
What are the two types of hydrocele?
Primary (idiopathic)
Secondary (to a testicular insult e.g. trauma, infection, cancer)
In what age groups do secondary hydroceles tend to occur?
Men ages 20-40 yrs because they are at greatest risk of having one of the initiating pathologies
How do you treat hydroceles?
Secondary – treat the cause
Primary – aspirate the fluid or undergo surgery
What usually causes epididymo-orchitis?
Acute infections of the testes and epididymis usually arise in the urinary tract or as STIs and ascend via the vas deferens
List some investigations for epididymo-orchitis.
Blood cultures – if the patient is septic, it is important to identify the causative organism
HIV test
Urine dipstick – look for signs of UTI (e.g. leucocytes and nitrites)
Urine MC&S – identify the causative organism
Urethral swab and GUM screen
