Scrotal mass diagnostic study of choice: Difference between revisions

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Latest revision as of 16:03, 16 December 2019

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

If there is an acutely painful scrotum,there should be a strong suspicion for testicular torsion, which is an emergency condition, and emergent surgical referral should be strongly considered. Sonography may be performed if testicular torsion is not suspected to confirm the diagnosis.^[1] Testicular torsion is primrily diagnosed base on the clinical presentation.^[2]

Diagnostic Study of Choice

Study of choice

Ultrasonography of the scrotom is the gold standard test for the differentiated diagnosis of scrotal mass.

Colored ultrasonography is specific and sensitive test for the diagnosis of epididymitis.

Testicular tortion is primarily diagnosed based on the clinical presentation.
MRI is sensetive test for diagnosis of hematocele.

Investigations:

Among the patients who present with clinical signs of epididymitis, the colored ultrasonography is the most specific test for the diagnosis.
Among the patients who present with clinical signs of epididymitis, the colored ultrasonography is the most sensitive test for diagnosis.
Among the patients who present with clinical signs of hematocele, the MRI is the most sensetive test for the diagnosis.

The comparison of various diagnostic studies for Testicular mass

Test	Sensitivity	Specificity	disease
ultrasonography	94	96	Tosticular Tortion
colored ultrasonography	100	90-100	Epididymitis

Diagnostic results

The following finding on performing ultrasonography is confirmatory for spermatocele:

Black area next to gray area

The following finding on performing ultrasonography is confirmatory for hydrocele:

Fluid surround testicle

The following finding on performing ultrasonography is confirmatory for varicocele:

Retrograde blood flow to the scrotom

Sequence of Diagnostic Studies

The ultrasonography must be performed when:

The patient presented with painless or painfull scrotal swelling as the first step of diagnosis.
A positive transillumination is detected in the patient, to confirm the hydrocele.

Name of Diagnostic Criteria

There are no established criteria for the diagnosis of scrotal mass. Testicular tortion is primarily diagnosed based on clinical presentation.

The evaluation of scrotal mass is as follows:

Adapted from American academy of family physicians.^[3]

Evaluation of the scrotal mass

Painful

Nonpainful

High-riding or horizontal testicle; nausea/vomiting?

Transilluminates?

Yes

No

Yes

No

Presumed torsion
Doppler ultrasonogram,
urology consult

Blue dot sign?

Hydrocele

"Bag of worms" on palpation that increases on Valsalva maneuvers

Yes

No

Yes

No

Torsion of testicular appendage

Lack of blood flow on doppler sonogram, C-reactive protein level <24 mg per L

Varicocele

Reducible mass?

Yes

No

Yes

No

Testicular torsion; urgent surgery

Likely epididymitis/orchitis, possibly incarcerated inguinal hernia, or hemorrhagic testicular cancer

Hernia

Extratesticular and nontender

Yes

No

Likely benign, further workup as needed

Doppler sonography prior to urology evaluation

Unilateral mass

Evaluate for testicular cancer: AFP, B-HCG, and LDH levels; MRI or CT scans may be considered to look for possible metastases and cryopreservation of sperm while awaiting urology evaluation

Diagnostic Approach Based on the Nature of the Testicular Swelling

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.^[3]

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.^[3]

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.^[3]

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.^[3]

References

↑ Scrotal mass. American Academy of Family Physicians 2016. http://www.aafp.org/afp/2008/1115/p1165.html. Accessed on March 18, 2016
↑ Crawford P, Crop JA (2014). "Evaluation of scrotal masses". Am Fam Physician. 89 (9): 723–7. PMID 24784335.
↑ ^3.0 ^3.1 ^3.2 ^3.3 ^3.4 Evaluation of scrotal mass. American academy of family physicians 2016. http://www.aafp.org/afp/2008/1115/p1165.html. Accessed on March 22, 2016

Template:WH Template:WS

[causescrotalmass1-1] Scrotal mass. American Academy of Family Physicians 2016. http://www.aafp.org/afp/2008/1115/p1165.html. Accessed on March 18, 2016

[pmid24784335-2] Crawford P, Crop JA (2014). "Evaluation of scrotal masses". Am Fam Physician. 89 (9): 723–7. PMID 24784335.

[pescrotalmass1-3] 3.0 ^3.1 ^3.2 ^3.3 ^3.4 Evaluation of scrotal mass. American academy of family physicians 2016. http://www.aafp.org/afp/2008/1115/p1165.html. Accessed on March 22, 2016

[1]

[2]

[3]

@@ Line 14: / Line 14: @@
 *Testicular tortion is primarily diagnosed based on the clinical presentation.
+*MRI is sensetive test for diagnosis of hematocele.
@@ Line 20: / Line 20: @@
 * Among the patients who present with clinical signs of epididymitis, the colored ultrasonography is the most specific test for the diagnosis.
 * Among the patients who present with clinical signs of epididymitis, the colored ultrasonography is the most sensitive test for diagnosis.
+* Among the patients who present with clinical signs of hematocele, the MRI is the most sensetive test for the diagnosis.
 ==== The comparison of various diagnostic studies for Testicular mass ====
@@ Line 40: / Line 40: @@
 |Epididymitis
 |}
-<small> [Name of test with higher sensitivity and specificity] is the preferred investigation based on the sensitivity and specificity</small>
 ===== Diagnostic results =====
-The following finding(s) on performing [investigation name] is(are) confirmatory for [disease name]:
+The following finding on performing ultrasonography is confirmatory for spermatocele:
-* [Finding 1]
+* Black area next to gray area
-* [Finding 2]
+The following finding on performing ultrasonography is confirmatory for hydrocele:
+*Fluid surround testicle
+The following finding on performing ultrasonography is confirmatory for varicocele:
+*Retrograde blood flow to the scrotom
 ===== Sequence of Diagnostic Studies =====
-The [name of investigation] must be performed when:
+The ultrasonography must be performed when:
-* The patient presented with symptoms/signs 1, 2, and 3 as the first step of diagnosis.
+* The patient presented with painless or painfull scrotal swelling as the first step of diagnosis.
-* A positive [test] is detected in the patient, to confirm the diagnosis.
+* A positive transillumination is detected in the patient, to confirm the hydrocele.
-OR
-The various investigations must be performed in the following order:
-* [Initial investigation]
-* [2nd investigation]
 === Name of Diagnostic Criteria ===
-'''It is recommended that you include the criteria in a table. Make sure you always cite the source of the content and whether the table has been adapted from another source.'''
+There are no established criteria for the diagnosis of scrotal mass.
+Testicular tortion is primarily diagnosed based on clinical presentation.
-[Disease name] is primarily diagnosed based on clinical presentation. There are no established criteria for the diagnosis of [disease name].
-OR
-There is no single diagnostic study of choice for [disease name], though [disease name] may be diagnosed based on [name of criteria] established by [...].
-OR
+*The evaluation of scrotal mass is as follows:
+<SMALL>Adapted from American academy of family physicians.<ref name="pescrotalmass1">Evaluation of scrotal mass. American academy of family physicians 2016. http://www.aafp.org/afp/2008/1115/p1165.html. Accessed on March 22, 2016</ref></SMALL>
-The diagnosis of [disease name] is made when at least [number] of the following [number] diagnostic criteria are met: [criterion 1], [criterion 2], [criterion 3], and [criterion 4].
-OR
-The diagnosis of [disease name] is based on the [criteria name] criteria, which includes [criterion 1], [criterion 2], and [criterion 3].
-OR
-[Disease name] may be diagnosed at any time if one or more of the following criteria are met:
-* Criteria 1
-* Criteria 2
-* Criteria 3
-OR
-'''IF there are clear, established diagnostic criteria'''
-The diagnosis of [disease name] is made when at least [number] of the following [number] diagnostic criteria are met: [criterion 1], [criterion 2], [criterion 3], and [criterion 4].
-OR
-The diagnosis of [disease name] is based on the [criteria name] criteria, which include [criterion 1], [criterion 2], and [criterion 3].
-OR
-The diagnosis of [disease name] is based on the [definition name] definition, which includes [criterion 1], [criterion 2], and [criterion 3].
-OR
-'''IF there are no established diagnostic criteria'''
-There are no established criteria for the diagnosis of [disease name].
-==References==
-{{Reflist|2}}
-{{WH}}
-{{WS}}
-==Evaluation of Scrotal Mass==
-*If there is an acutely painful scrotum,there should be a strong suspicion for testicular torsion, which is an emergency condition, and emergent surgical referral should be strongly considered. Sonography may be performed if testicular torsion is not suspected to confirm the diagnosis.<ref name="causescrotalmass1">Scrotal mass. American Academy of Family Physicians 2016. http://www.aafp.org/afp/2008/1115/p1165.html. Accessed on March 18, 2016</ref>
-*The evaluation of scrotal mass is as follows:<ref name="causescrotalmass1">Scrotal mass. American Academy of Family Physicians 2016. http://www.aafp.org/afp/2008/1115/p1165.html. Accessed on March 18, 2016</ref>
 {{familytree/start |summary=Evaluation of the scrotal mass}}
@@ Line 139: / Line 92: @@
 {{familytree |boxstyle=background: #DCDCDC;| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | I01 | |I01=<div style="width: 9em; padding:0.2em;">Evaluate for testicular cancer: AFP, B-HCG, and  LDH levels; MRI or CT scans may be considered to look for possible metastases and cryopreservation of sperm while awaiting urology evaluation</div>}}
 {{familytree/end}}
-<SMALL>Adapted from American academy of family physicians.<ref name="pescrotalmass1">Evaluation of scrotal mass. American academy of family physicians 2016. http://www.aafp.org/afp/2008/1115/p1165.html. Accessed on March 22, 2016</ref></SMALL>
+===Diagnostic Approach Based on the Nature of the Testicular Swelling===
+===Swelling of the Testis===
+<br>
+{{familytree/start |summary=Swelling of the testis}}
+{{familytree |boxstyle=background: #DCDCDC;| | | | | | | | | | | | | | | A01 |A01=<div style="width: 9em; padding:0.2em;">'''Swelling of the testis'''</div>}}
+{{familytree |boxstyle=background: #DCDCDC;| | | | | | | |,|-|-|-|-|-|-|-|^|-|-|-|-|-|-|-|.| | |}}
+{{familytree |boxstyle=background: #DCDCDC;| | | | | | | B01 | | | | | | | | | | | | | | B02 | |B01=<div style="width: 9em; padding:0.2em;">Tender, onset <24 hours</div>|B02=<div style="width: 9em; padding:0.2em;">Nontender, gradual onset</div>}}
+{{familytree |boxstyle=background: #DCDCDC;| | | | | | | |!| | | | | | | | | | | |,|-|-|-|^|-|-|-|.| |}}
+{{familytree |boxstyle=background: #DCDCDC;| | | | | | | C01 | | | | | | | | | | C02 | | | | | | C03 |C01=<div style="width: 9em; padding:0.2em;">Torsion versus orchitis</div>|C02=<div style="width: 9em; padding:0.2em;">Solid</div>|C03=<div style="width: 9em; padding:0.2em;">Transilluminates</div>}}
+{{familytree |boxstyle=background: #DCDCDC;| | | | | | | |!| | | | | | | | | | | |!| | | | | | | |!| |}}
+{{familytree |boxstyle=background: #DCDCDC;| | | | | | | D01 | | | | | | | | | | D02 | | | | | | D03 | |D01=<div style="width: 9em; padding:0.2em;">Emergent surgical referral</div>|D02=<div style="width: 9em; padding:0.2em;">Suspect testicular cancer; order sonography or refer</div>|D03=<div style="width: 9em; padding:0.2em;">Yes</div>|D03=<div style="width: 9em; padding:0.2em;">Hydrocele obscuring testis; order sonography to confirm</div>}}
+{{familytree/end}}
+<SMALL>Adapted from American academy of family physicians.<ref name=pescrotalmass1>Evaluation of scrotal mass. American academy of family physicians 2016. http://www.aafp.org/afp/2008/1115/p1165.html. Accessed on March 22, 2016</ref></SMALL>
+===Swelling of the Epididymis===
+<br>
+{{familytree/start |summary=Swelling of the epididymis}}
+{{familytree |boxstyle=background: #DCDCDC;| | | | | | | | | | | | | | | A01 |A01=<div style="width: 9em; padding:0.2em;">'''Swelling of the epididymis'''</div>}}
+{{familytree |boxstyle=background: #DCDCDC;| | | | | | | |,|-|-|-|-|-|-|-|^|-|-|-|-|-|-|-|.| | |}}
+{{familytree |boxstyle=background: #DCDCDC;| | | | | | | B01 | | | | | | | | | | | | | | B02 | |B01=<div style="width: 9em; padding:0.2em;">Diffusely swollen, tender, acute onset</div>|B02=<div style="width: 9em; padding:0.2em;">Nodule, stable in size</div>}}
+{{familytree |boxstyle=background: #DCDCDC;| | | | | | | |!| | | | | | | | | | | | | | | |!| | | |}}
+{{familytree |boxstyle=background: #DCDCDC;| | | | | | | C01 | | | | | | | | | | | | | | C02 | | | |C01=<div style="width: 9em; padding:0.2em;">Epididymitis</div>|C02=<div style="width: 9em; padding:0.2em;">Spermatocele; sonography to confirm</div>}}
+{{familytree/end}}
+<SMALL>Adapted from American academy of family physicians.<ref name=pescrotalmass1>Evaluation of scrotal mass. American academy of family physicians 2016. http://www.aafp.org/afp/2008/1115/p1165.html. Accessed on March 22, 2016</ref></SMALL>
+===Swelling of the Spermatic Cord===
+<br>
+{{familytree/start |summary=Swelling of the spermatic cord}}
+{{familytree |boxstyle=background: #DCDCDC;| | | | | | | | | | | | | | | A01 |A01=<div style="width: 9em; padding:0.2em;">'''Swelling of the spermatic cord'''</div>}}
+{{familytree |boxstyle=background: #DCDCDC;| | | | | | | |,|-|-|-|-|-|-|-|+|-|-|-|-|-|-|-|.| | |}}
+{{familytree |boxstyle=background: #DCDCDC;| | | | | | | B01 | | | | | | B02 | | | | | | B03 | |B01=<div style="width: 9em; padding:0.2em;">Swelling extends to inguinal ring</div>|B02=<div style="width: 9em; padding:0.2em;">"Bag of worms" texture</div>|B03=<div style="width: 9em; padding:0.2em;">Smooth, transilluminates</div>}}
+{{familytree |boxstyle=background: #DCDCDC;| | | | | | | |!| | | | | | | |!| | | | | | | |!| | | |}}
+{{familytree |boxstyle=background: #DCDCDC;| | | | | | | C01 | | | | | | C02 | | | | | | C03 | | | |C01=<div style="width: 9em; padding:0.2em;">Indirect inguinal hernia</div>|C02=<div style="width: 9em; padding:0.2em;">Varicocele</div>|C03=<div style="width: 9em; padding:0.2em;">Hydrocele</div>}}
+{{familytree/end}}
+<SMALL>Adapted from American academy of family physicians.<ref name=pescrotalmass1>Evaluation of scrotal mass. American academy of family physicians 2016. http://www.aafp.org/afp/2008/1115/p1165.html. Accessed on March 22, 2016</ref></SMALL>
+===Swelling of the Skin===
+<br>
+{{familytree/start |summary=Swelling of the skin}}
+{{familytree |boxstyle=background: #DCDCDC;| | | | | | | | | | | | | | | A01 |A01=<div style="width: 9em; padding:0.2em;">'''Swelling of the skin'''</div>}}
+{{familytree |boxstyle=background: #DCDCDC;| | | | | | | |,|-|-|-|-|-|-|-|^|-|-|-|-|-|-|-|.| | |}}
+{{familytree |boxstyle=background: #DCDCDC;| | | | | | | B01 | | | | | | | | | | | | | | B02 | |B01=<div style="width: 9em; padding:0.2em;">Irregular, enlarging; occupational risk</div>|B02=<div style="width: 9em; padding:0.2em;">Smooth, cystic, stable in size</div>}}
+{{familytree |boxstyle=background: #DCDCDC;| | | | | | | |!| | | | | | | | | | | | | | | |!| | |}}
+{{familytree |boxstyle=background: #DCDCDC;| | | | | | | C01 | | | | | | | | | | | | | | C02 |C01=<div style="width: 9em; padding:0.2em;">TRule out squamous cell carcinoma</div>|C02=<div style="width: 9em; padding:0.2em;">Sebaceous cyst</div>}}
+{{familytree/end}}
+<SMALL>Adapted from American academy of family physicians.<ref name=pescrotalmass1>Evaluation of scrotal mass. American academy of family physicians 2016. http://www.aafp.org/afp/2008/1115/p1165.html. Accessed on March 22, 2016</ref></SMALL>
 ==References==
 {{Reflist|2}}
 {{WH}}
 {{WS}}

Scrotal mass diagnostic study of choice: Difference between revisions

Latest revision as of 16:03, 16 December 2019

Overview

Diagnostic Study of Choice

Study of choice

The comparison of various diagnostic studies for Testicular mass

Diagnostic results

Sequence of Diagnostic Studies

Name of Diagnostic Criteria

Diagnostic Approach Based on the Nature of the Testicular Swelling

Swelling of the Testis

Swelling of the Epididymis

Swelling of the Spermatic Cord

Swelling of the Skin

References

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