Scrotal mass diagnostic study of choice

Scrotal Mass Microchapters
Home
Patient Information
Overview
Historical Perspective
Classification
Pathophysiology
Causes
Differentiating Scrotal Mass from other Diseases
Epidemiology and Demographics
Risk Factors
Screening
Natural History, Complications, and Prognosis
Diagnosis
Diagnostic Study of Choice
History and Symptoms
Physical Examination
Laboratory Studies
Electrocardiogram
X-ray
Echocardiography and Ultrasound
CT scan
MRI
Other Imaging Findings
Other Diagnostic Studies
Treatment
Medical Therapy
Surgery
Primary Prevention
Secondary Prevention
Cost-Effectiveness of Therapy
Future or Investigational Therapies
Case Studies
Case #1
Scrotal mass diagnostic study of choice On the Web
Most recent articles
Most cited articles
Review articles
CME Programs
Powerpoint slides
Images
American Roentgen Ray Society Images of Scrotal mass diagnostic study of choice All Images X-rays Echo & Ultrasound CT Images MRI
Ongoing Trials at Clinical Trials.gov
US National Guidelines Clearinghouse
NICE Guidance
FDA on Scrotal mass diagnostic study of choice
CDC on Scrotal mass diagnostic study of choice
Scrotal mass diagnostic study of choice in the news
Blogs on Scrotal mass diagnostic study of choice
Directions to Hospitals Treating bone or soft tissue mass
Risk calculators and risk factors for Scrotal mass diagnostic study of choice

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. Testicular torsion is primrily diagnosed base on the clinical presentation.

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 [name of investigation] must be performed when:

• The patient presented with symptoms/signs 1, 2, and 3 as the first step of diagnosis.
• A positive [test] is detected in the patient, to confirm the diagnosis.

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.

[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 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].

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.
• The evaluation of scrotal mass is as follows:

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

Adapted from American academy of family physicians.