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Causes of Scrotal Lesions by Anatomic Origin

AGGRAVATING/ALLEVIATIN
ANATOMIC LESION/CONDITIO ONSET/PROGRESSIO PAIN/TENDERNES G FACTORS, ASSOCIATED
ORIGIN N N S SYMPTOMS

Skin Sebaceous cyst Acute/chronic, stable No

Squamous cell Chronic, progressive No


carcinoma

Tunica Hydrocele Acute/chronic, stable No Transilluminates


vaginalis
testis
Hematocele Acute, caused by Yes Does not transilluminate well
trauma

Processus Indirect inguinal Acute/chronic, stable No; yes if May enlarge with Valsalva-
vaginalis hernia or progressive strangulated type maneuvers; size may
testis fluctuate

Hydrocele Chronic, stable No

Pampinifor Varicocele Chronic, stable No Bag of worms consistency


m plexus

Epididymis Epididymitis Acute, progressive Yes May have symptoms of


urinary tract infection

Spermatocele Chronic, stable No


AGGRAVATING/ALLEVIATIN
ANATOMIC LESION/CONDITIO ONSET/PROGRESSIO PAIN/TENDERNES G FACTORS, ASSOCIATED
ORIGIN N N S SYMPTOMS

Testis Testicular torsion Acute, progressive Yes Elevation of testis may


aggravate pain; abnormal
testicular lie; cremasteric
reflex usually absent

Appendix testis Acute, stable Yes Blue dot sign


torsion

Orchitis Acute, self-limited Yes Elevation of testis may


relieve pain, may have
systemic symptoms of viral
illness

Testicular cancer Chronic, progressive No


Overview of the Causes of Scrotal Masses
CAUSE CLINICAL PRESENTATION DIAGNOSIS TREATMENT

Testicular torsion Acute unilateral pain Clinical, with or Surgery


and swelling without
ultrasonography
Abnormal cremasteric
reflex
High position of the
testicle
Nausea/vomiting

Epididymitis/orchitis Acute unilateral pain Clinical, with or Ceftriaxone


and swelling without (Rocephin)
ultrasonography and
Dysuria doxycycline
Erythema of the scrotal
skin
Fever

Torsion of the Acute unilateral pain Ultrasonography Pain control


testicular appendage
Blue dot sign (i.e.,
bluish discoloration of
the scrotum over the
superior pole)

Hematocele or History of trauma Ultrasonography or Pain control;


testicular rupture surgical exploration surgery if
Pain and swelling needed

Testicular cancer Firm, unilateral nodule Ultrasonography, Surgery


tumor markers
CAUSE CLINICAL PRESENTATION DIAGNOSIS TREATMENT

Inguinal hernias Pain with Valsalva Physical Surgery


maneuvers examination,
ultrasonography
Unilateral bulge in the
scrotum

Hydrocele Swelling Transillumination, Pain control;


ultrasonography surgery if
needed

Varicocele Dull ache when Bag of worms on Scrotal


standing palpation support;
surgery if
Scrotal mass needed

Skin cancer History of carcinogens Biopsy Surgery


Erosive, vascular,
hyperkeratotic, or
nonhealing; color
changes; irregular
border

Information from references 1, 2, 4, and 6 through 8.