Scrotal Mass

Aka: Scrotal Mass, Scrotal Lesion, Groin Mass, Inguinal Mass, Scrotal Swelling, Groin Swelling, Inguinal Swelling, Testicular Swelling, Scrotal Edema, Testicular Mass, Testicular Lump

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II. Causes: Groin Swelling

  1. Undescended Testicle (Cryptorchidism)
  2. Inguinal Lymphadenopathy (or Lymphadenitis, e.g. Chlamydia, Lymphogranuloma venereum)
  3. Femoral arterial aneurysm or pseudoaneurysm
  4. Inguinal Hernia
  5. Femoral Hernia
  6. Hematoma
  7. Hidradenitis Suppurativa
  8. Lipoma
  9. Lymphoma
  10. Metastatic cancer
  11. Psoas abscess
  12. Sebaceous Cyst

III. Causes: Generalized Edema

  1. Lymphedema
  2. Fournier's Gangrene
  3. Anasarca
    1. Congestive Heart Failure
    2. Renal Failure
    3. Hepatic Failure with Ascites

IV. Causes: Skin Lesions

  1. See Scrotal Skin Lesion

V. Causes: Scrotal, Testicular or Epididymis Swelling

  1. See Scrotal Pain
  2. Acute and Tender
    1. Testicular Torsion
      1. Acute unilateral Scrotal Swelling and Scrotal Pain
      2. Pain not relieved with Prehn's Sign (unreliable)
      3. Associated with a high riding Testicle and Nausea or Vomiting
    2. Torsion of Testicular Appendage
      1. Acute, gradual onset of intense pain at the superior pole of the Testicle
      2. Blue dot sign (blue discoloration at the Testicle's superior pole) is pathognomonic
    3. Orchitis or Epididymitis
      1. Acute unilateral Scrotal Swelling and pain adjacent to Testicle and may be relieved with Prehn's Sign
      2. May be associated with Dysuria, fever, scrotal erythema
      3. Increased C-Reactive Protein (CRP) >24 mg/ml in most cases
  3. Chronic and Non-tender
    1. Varicocele
      1. Soft lumps superior to the Testicle (bag of worms), esp. in left Scrotum
      2. Dull ache or heaviness Sensation may be present, worse with standing or Valsalva Maneuver
    2. Testicular carcinoma
      1. Firm, unilateral Nodule (may present with pain in some cases)
    3. Hydrocele
      1. Mobile, ovoid, non-tender Scrotal Mass superior or adjacent to the Testicle
      2. Fluid collection around the Testicle that transilluminates
    4. Hematocele
      1. Trauma induced blood collection around Testicle (evaluate for testicular rupture)
    5. Spermatocele
      1. Palpable swelling within the spermatic cord, often near the Testicle (typically after Vasectomy)
    6. Inguinal Hernia
      1. Soft mass in the Scrotum or Inguinal Canal
      2. Indirect Inguinal Hernia often palpable with Valsalva Maneuver
    7. Epidermoid Cyst
      1. Asymptomatic, firm, round Nodule beneath the skin surface
      2. Cyst contains foul smelling, cottage cheese material

VI. Causes: Spermatic cord swelling

  1. Indirect Inguinal Hernia
    1. Typically unilateral bulging of Scrotum provoked with Valsalva Maneuver
  2. Varicocele
    1. Dull ache-type Scrotal Pain provoked with standing
    2. "Bag of worms" like swelling
  3. Hydrocele
    1. Fluid collection around the Testicle that transilluminates

VII. History

  1. Is pain present?
  2. Timing (acute or chronic)?
  3. Exacerbating and palliative factors?
  4. Associated constitutional symptoms (e.g. fever, chills, Night Sweats, weight loss)?
  5. Abdominal Pain?
  6. Dysuria?
  7. Hematuria?

VIII. Exam

  1. Palpate Testicle and spermatic cord for Nodules or masses
  2. Cremasteric Reflex
  3. Prehn Sign
  4. Inguinal Canal palpation with Valsalva Maneuver
  5. Transillumination of the Scrotum (Hydrocele allows light transmission)

IX. Imaging: Scrotal Ultrasound with Doppler Imaging

  1. Scrotal Ultrasound is indicated in most cases of Scrotal Mass
  2. Testicular Torsion is an emergency and requires immediate evaluation

X. References

  1. Cristoforo (2019) Crit Dec Emerg Med 33(10): 15-20
  2. Butani (2022) Am Fam Physician 106(5): 571-2 [PubMed]
  3. Langan (2022) Am Fam Physician 106(2): 184-9 [PubMed]
  4. LeBlanc (2013) Am Fam Physician 87(12): 844-8 [PubMed]
  5. Crawford (2014) Am Fam Physician 89(9): 723-7 [PubMed]
  6. Thomas (2022) Am Fam Physician 105(1): 77-8 [PubMed]

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