Scrotal mass physical examination
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]Associate Editor(s)-in-Chief: Niloofarsadaat Eshaghhosseiny, MD[2]Sujit Routray, M.D. [3]
Overview
Common physical examination findings of scrotal mass include swelling and tender mass which is having a smooth, twisted, or irregular shape and liquid, firm, or solid in consistency. The ipsilateral inguinal lymph nodes may be enlarged or tender. physical examination of scrotal masses depends on causes.common physical examinations in testicular tortion is an elevated ,horizontlly aligned testicle. Also they have severe tenderness and firm in palpation.Cremastic reflex and phren sign are absent.In testicular apendix tortion ,phathognomonic sign is Blue dot,which is a nodule with blue discoloration.In hydrocele transillumination test will be positive.
Physical Evaluation
The physical examination findings of scrotal mass depend on the cause of the mass. The likely diagnoses of a scrotal mass based on physical examination findings include:[1]
Swelling of the Testis
Swelling of the testis | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Tender, onset <24 hours | Nontender, gradual onset | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Torsion versus orchitis | Solid | Transilluminates | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Emergent surgical referral | Suspect testicular cancer; order sonography or refer | Hydrocele obscuring testis; order sonography to confirm | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Adapted from American academy of family physicians.[1]
Swelling of the Epididymis
Swelling of the epididymis | |||||||||||||||||||||||||||||||||||||||||||||||||||||||
Diffusely swollen, tender, acute onset | Nodule, stable in size | ||||||||||||||||||||||||||||||||||||||||||||||||||||||
Epididymitis | Spermatocele; sonography to confirm | ||||||||||||||||||||||||||||||||||||||||||||||||||||||
Adapted from American academy of family physicians.[1]
Swelling of the Spermatic Cord
Swelling of the spermatic cord | |||||||||||||||||||||||||||||||||||||||||||||||||||||||
Swelling extends to inguinal ring | "Bag of worms" texture | Smooth, transilluminates | |||||||||||||||||||||||||||||||||||||||||||||||||||||
Indirect inguinal hernia | Varicocele | Hydrocele | |||||||||||||||||||||||||||||||||||||||||||||||||||||
Adapted from American academy of family physicians.[1]
Swelling of the Skin
Swelling of the skin | |||||||||||||||||||||||||||||||||||||||||||||||||||||
Irregular, enlarging; occupational risk | Smooth, cystic, stable in size | ||||||||||||||||||||||||||||||||||||||||||||||||||||
TRule out squamous cell carcinoma | Sebaceous cyst | ||||||||||||||||||||||||||||||||||||||||||||||||||||
Adapted from American academy of family physicians.[1]
Physical Examination
Physical examination of patients with testicular tortion is usually remarkable for horizontally aligned testicle, absence of cremasteric reflex, and phern sign.[2]
The presence of blu dot sign on physical examination is diagnostic of testicular appendix tortion.[2]
The presence of bag of worms on physical examination is highly suggestive of varicocele.[3]
The presence of transillumination test on physical examination is highly suggestive of hydrocele.[3]
Appearance of the Patient
- Depond on the cause of scrotal mass is different.
- Patients with painfull scrotal usually appear ill and patients without pain usually apear normal.
Vital Signs
- In epididymitis may have low-grade fever
Skin
- Skin examination of patients with scrotal mass is usually normal.
- In epididymitis scrotal skin on the affected side may be erythematous.
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Description (Adapted from Dermatology Atlas)
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Description (Adapted from Dermatology Atlas)
HEENT
- HEENT examination of patients with scrotal mass is usually normal.
Neck
- Neck examination of patients with scrotal mass is usually normal.
- Patients with scrotal cancer with metastesis may present with neck mass.
Lungs
- Pulmonary examination of patients with scrotal mass is usually normal.
Heart
- Cardiovascular examination of patients with scrotal mass is usually normal.
Abdomen
- Abdominal examination of patients with scrotal mass is usually normal.
- Paitient with scrotal cancer with metastetis may present with :
- Abdominal distension
- Abdominal tenderness
- Abdominal mass
Back
- Back examination of patients with scrotal mass is usually normal.
Genitourinary
- Swallon testis
- Abnormal testis position
- Bag of worms on palpation
- Tender and palpable nodule
- Absence of cremasteric reflex
- Posetive tranillumination
Neuromuscular
- Neuromuscular examination of patients with scrotal mass is usually normal.
Extremities
- Extremities examination of patients with scrotal mass is usually normal.
References
- ↑ 1.0 1.1 1.2 1.3 1.4 Evaluation of scrotal mass. American academy of family physicians 2016. http://www.aafp.org/afp/2008/1115/p1165.html. Accessed on March 22, 2016
- ↑ 2.0 2.1 OʼReilly P, Le J, Sinyavskaya A, Mandel ED (2016). "Evaluating scrotal masses". JAAPA. 29 (2): 26–32. doi:10.1097/01.JAA.0000476208.04443.ca. PMID 26757064.
- ↑ 3.0 3.1 Gordhan CG, Sadeghi-Nejad H (2015). "Scrotal pain: evaluation and management". Korean J Urol. 56 (1): 3–11. doi:10.4111/kju.2015.56.1.3. PMC 4294852. PMID 25598931.