Examination of Scrotal Swellings

Question 1

What are the four questions to ask in the examination of scrotal swellings?

Answer 1

• Can you get above the swelling?
• Can the testis and epididymis be identified separately?
• Does the swelling transilluminate?
• Is the swelling tender?

Question 2

What info do we need to ascertain about a testicular swelling?

Answer 2

It is first necessary to confirm that the swelling originates within the scrotum and is not an inguinoscrotal hernia. A hernia may be reducible, may have a cough impulse and the testis should be palpable. On palpation, you cannot ‘get above’ a hernia. You also cannot get above an infantile hydrocoele, which is due to a patent processus vaginalis. However, this is irreducible, has no cough impulse and the testis is impalpable.

Question 3

If the lump originates in the testicle what is our differential?

Answer 3

o testicular tumours (testis and epididymis definable, lump within testis, testis non- tender)
 o orchitis (testis and epididymis usually definable, testis tender) 
o torsion of the testis (typically adolescent boys, presents with acute scrotal pain, occasionally with abdominal pain) 
o torsion of the testicular appendix (hydatid of Morgagni) (presents with acute but less severe scrotal pain, tender spot at upper pole of testis may have blue dot sign, hydrocoele often present)

Question 4

if the lump originates as Processus vaginalis remnants, what is our differential?

Answer 4

o Hydrocoele – a fluid-filled sac that surrounds the testis anteriorly. Note that a hydrocoele can obscure a testicular tumour. (Testis and epididymis nonpalpable, transilluminates brightly)
o haematocoele – as with a hydrocoele but containing blood, e.g. after testicular trauma or haemorrhage from a testicular tumour (Testis and epididymis nonpalpable, does not transilluminate)

Question 5

If the lump originates at the epididymis, what is our differential?

Answer 5

o epididymal cyst (testis and epididymis definable, lump separate from testis, testis and epididymis non tender, lump may transilluminate) 
o epididymitis (testis and epididymis definable, lump separate from testis, epididymis tender)

Question 6

If the lump originates at the pampiform venous plexus, what is our differential?

Answer 6

o (varicose enlargement of the venous plexus)

o Examine standing up and use Valsalva to try to palpate varicocoele