creation date: 2026-08-10 17:21
tags: Workups
Scrotal Mass
Background
Pathophysiology
Differential Diagnosis
Immediately emergent
Non-emergent
- Epididymitis/epididymoorchitis
- Apendage torsion
- Incarcerated/strangulated inguinal hernia
- Traumatic hematoma
- Testicular cancer
Benign
- Spermatocele / epididymal cyst
- Hydrocele
- Varicocele (may be concerning if right sided)
Initial Evaluation
History
History should include:
- Onset and duration
- Associated symptoms including pain
- History of trauma, infection, surgery
History should rule out concerning features of testicular torsion. Suspicion of such should proceed accordingly.
Physical Exam
Physical exam consist of palpation of the scrotum. A systematic approach should be used to assess:
- Scrotal fullness (size, “bag of worms”) - suggestive of varicocele
- Unitlateral or bilateral diffuse swelling, uniform in consistency - hydrocele
- Localized fullness at head of epididymis - epididymal cyst of spermatocele
- FIrm, nontender nodule/mass on testis - testicular cancer
- Mass in paratesticular tissue or tail in epididymis - adenomatoid tumour
Transillumination of the scrotum may be helpful (hydrocele permits transillumination).
Investigations
If the diagnosis is unclear from initial evaluation, a scrotal ultrasound should be performed. US is >95% sensitive for concerning intratesticular lesions, of which should be referred to urology.