genitourinary disorders
Painless Scrotal Mass
Evaluation of Painless Scrotal Mass
History of present illnessshould address duration of symptoms, the effect of upright position and increase in intra-abdominal pressure, and presence and characteristics of associated symptoms such as pain. should seek symptoms suggesting possible causes, including abdominal pain, anorexia, or vomiting ( Hernias of the Abdominal Wall with intermittent strangulation); dyspnea and leg swelling (right heart failure); abdominal distention ( should identify existing disorders that can cause masses (eg, right Heart Failure (HF) , ascites causing bilateral lymphedema); known scrotal disorders (eg, Physical examination includes evaluation for systemic disorders that can cause edema (eg, heart failure, ascites) and detailed inguinal and genital examination. Inguinal and genital examination should be done with patients standing and recumbent. The inguinal area is inspected and palpated, particularly for reducible masses. The testes, epididymides, and spermatic cords should be palpated for swelling, masses, and tenderness. Careful palpation can usually localize a discrete mass to one of these structures. Nonreducible masses should be transilluminated to help determine whether they are cystic or solid. The following findings are of particular concern: Nonreducible mass that obscures normal spermatic cord structures Mass that is part of or attached to the testis and does not transilluminate A nonreducible mass that obscures normal spermatic cord structures suggests an incarcerated inguinal hernia. If a mass is part of or attached to the testis and does not transilluminate, Testicular Cancer is possible. Other clinical characteristics can provide important clues (see table Some Causes of a Painless Scrotal Mass . For example, a mass that transilluminates is probably cystic (eg, hydrocele, spermatocele). A mass that disappears or becomes smaller when recumbent suggests varicocele, inguinal hernia, or communicating hydrocele. The presence of a hydrocele makes assessment for other scrotal masses by examination difficult. Rarely, a varicocele persists when the patient is recumbent or is present on the right side; either finding suggests inferior vena caval obstruction. Clinical evaluation may be diagnostic (eg, in varicocele, Lymphedema , The diagnosis is uncertain Usually when hydrocele is present (to diagnose causative scrotal lesions) The mass does not transilluminate If ultrasonography confirms a solid testicular mass, further testing is done for testicular cancer (see Diagnosis ), including the following: Beta-human chorionic gonadotropinlevel (hCG) Alpha-fetoprotein level Lactic dehydrogenase level CT of the abdomen 