DDx of scrotal mass:
Cancer
Torsion, epididymitis, epididymorchitis, hydrocele, spermatocele, varicocele, inguinal hernia, mumps, testicular appendage, swollen testicle after trauma, non-testicular tumor (paratesticular tumor: e.g., rhabdomyosarcoma, leiomyosarcoma, liposarcoma)
Torsion of spermatic cord resulting in venous outflow obstruction and subsequent arterial occlusion → infarction of testicle.
Onset of scrotal pain usually after vigorous activity or minor trauma
Usually seen in adolescence
Bell clapper deformity: b/l nonattachment of the testicles by the gubernaculum of the scrotum (free like the clappers of a bell)
Pain in scrotum, suprapubic pain, tender swollen testicles, elevated testicles, nonillumination, absence of cremasteric reflex
U/S and doppler flow study, cold Tc-99m scan (nuclear study), surgical exploration
Tx: surgical detorsion and b/l ochiopexy to the scrotum.
less than 6 hr will bring the best result; >90% salvage rate. After 24 h <10% salvage rate.
epididymitis is inf of epididymis. Swollen, tender testicle; dysuria, scrotal ache/pain, fever, chills, scrotal mass. Bacteria in urethra. E. coli, Gonorrhea, chlamydia.
UA, urine cx, swab if STI suspected. U/S w/ dopper, nuclear study.
Abx.
Phren's sign: elevation of the painful testicle, reduces pain of the epididymitis
Fournier's gangrene: extensive tissue necrosis/infection of the perineum in patients with diabetes.