Scrotal Mass Flashcards
What questions should be asked about a scrotal mass
Is it painful? - exclude torsion, most tumours are not painful
How long has been there? (hours - torsion | weeks/months - tumour)
What made them notice the lump? (what encouraged them to check their testicles)
Has it changed in size?
Is the lump always there? (inguinal lumps -coughing/sneezing | varicocele disappear on lying flat)
Any other lumps?
Other symptoms (UTI, STI symptoms)
Recent trauma to testes?
Do the testes feel heavy? (raised suspicion for cancer)
What are the key characteristics of a testicular exam of a scrotal mass
Tenderness
Can you get above it? (does it extend proximally - hernia)
Is it possible to palpate the testis separately
Does it transilluminate?
What are the differentials for a scrotal mass
Hydrocele Acute epididymitis Orchitis Epididymo-orchitis Inguinalscrotal hernia Cancer Epididymal cyst Testicular torsion Acute idiopathic scrotal oedema, Torsion of hydatid or Morgagni, TB epididymitis, Post vasectomy sperm granulomata, acute/chronic haemotacele, gunma
What is the typical examination for a testicular tumour
Non-tender and solid mass within the testis
Associated with abnormal testicular sensation
Nodule or ill-define circumferential swelling
What is the biggest risk factor for testicular tumours
History of undescended or maldescended testes
Which lymph nodes should be palpated for suspected testicular tumour
Para-aortic nodes (centre of abdomen, above umbilicus)
Supra-clavicular nodes
What investigations should be requested for suspected testicular tumour
Ultrasound scan
Tumour markers (alpha fetoprotein, beta-HCG, LDH)
Staging scans - CXR and CT CAP
Describe a typical epididymal cyst on exam
Irregularly shaped fluctuant mass that is distinct from the testis (superior and posterior to the testis)
Possible to get above the mass
Transilluminates
Tender to palpation
Feels multilocular
Testis itself feels normal and overlying skin is also normal
Describe a typical hydrocele on exam
Large fluctuant mass Possible to get above the lump Not possible to distinguish the testis Transilluminates Tender
What features would suggest epididymo-orchitis rather than testicular torsion
Systemic symptoms
Febrile
(swollen, red, tender, warm scrotum)
History suggestive of STI or URI
What investigations should be ordered for suspected epididymo-orchitis
Blood cultures HIV testing FBC Urine dipstick + MC+S Urethral swab and GUM screen
Which side are varicoceles more common on and what does a sudden appearance in an otherwise normal testes
Left
Sudden appearance - important presentation of renal tumours (e.g. renal cell carcinoma) as the tumour invades the left renal vein to compromise drainage of the L gonadal vein
What pathogens are most likely to cause epididymo-orchitis in patients <35 and >35
<35 - STI e.g. chlamydia trachomatis and Neisseria Gonorrhoea
> 35 - E. Coli
What should be considered in a boy with a swelling adjacent to the jaw and then a swollen testis
Mumps
