Scrotal pain, and painful scrotal masses or swelling (scrotal pain) may be caused by torsion, Appendixtorsion, epididymitis, epididymo, scrotal abscess, trauma, strangulated hernia, orchitis and Fournier gangrene.
A painless scrotal mass is often noticed by patients, but may be a chance finding of a routine physical examination. Scrotal pain, and painful scrotal masses or swelling (scrotal pain) may be caused by torsion, Appendixtorsion, epididymitis, epididymo, scrotal abscess, trauma, strangulated hernia, orchitis and Fournier gangrene. Etiology There are several causes (s causes a painless scrotal mass.) A painless scrotal mass, but the most common include the following: hydrocele Nichtinkarzerierter hernia varicocele (up to 20% of adult men) Less common causes include spermatocele, hematocele, fluid overload, and occasionally testicular cancer. Testicular cancer is the major cause of painless scrotal mass. Although it is rare compared to the other listed causes, it is the most common solid cancer in men <40 years. Since he responds well to treatment, early diagnosis is important. Causes a painless scrotal mass cause suspicious findings diagnostic approach hydrocele ( "communicating") Cystic swelling magnification when aufgerichet or when intra-abdominal pressure increases Most congenital Translucent Clinical evaluation sonography when diagnosis is uncertain hydrocele ( "noncommunicating") Cystic swelling No change in size at position change of the intra-abdominal pressure is often a simultaneous scrotal anomaly ( eg., tumor, epididymitis) Translucent Clinical Evaluation Usually sonography spermatocele Cystic mass in the upper pole of the testis, Clinical near the epididymis Translucent rating sonography when diagnosis is uncertain hernia magnification when erect or when intra-abdominal pressure increases can in lying disappear or shrink or compress Maybe No bowel sounds normal structures of the spermatic cord above the mass may in the inguinal canal to feel Clinical evaluation Varicocele can be felt while standing, feels like a "bag of worms" on. Usually on the left side may pain and bloating when standing may testicular atrophy Clinical evaluation hematocele Painful swelling risk factors (eg. As trauma, surgery, bleeding disorders or using anticoagulants) usually sonography fluid overload Diffuse bilateral enlargement of the scrotum often pits often obvious causative disease (z. B. heart failure, ascites) Translucent Clinical evaluation sonography when diagnosis is uncertain Lymphedema (eg. B. of filariasis, congenital, idiopathic) Diffuse scrotal swelling often "nonpitting" Clinical evaluation sonography when diagnosis is uncertain testicular cancer lesion close to or part of the testicle is fixed or not translucent Possibly dull, agonizing or acute pain due to bleeding sonography ?-fetoprotein ? -Humanes chorionic gonadotropin LDH CT of the abdomen assessment history in the history of the present illness, the duration of symptoms, the effect should be the on right position and the increase of intra-abdominal pressure as well as accompanying and charakteristeische symptoms such as pain are considered. By checking the Organsysysteme should be looked for symptoms that give indications of possible causes. These include abdominal pain, anorexia or vomiting (hernia with "intermittent strangulation"); Shortness of breath and leg swelling (heart failure right); abdominal voltage (ascites); decreased libido, feminization and infertility (testicular atrophy with bilateral "Varicoceles"). The medical history should existing diseases that can cause Raumfprderungen are detected (for example, right-sided heart failure;. Ascites, lymphedema caused bilateral); as well as known scrotal disorders (eg. as testicular tumors or epididymitis, leading to hydroceles) and Leistenbruch.Körperliche examination The physical examination includes an assessment of systemic diseases that can cause edema (z. B. heart failure, ascites), a specific investigation the groin and genital area. The inguinal and genital examination should be done with the patient standing and lying. The groin is examined and palpated, and in particular "reducible masses". The testes, epididymis and vas deferens should be scanned for lumps, lesions and sensitivity. Careful palpation can locate a single mass in one of these structures generally. "Nonreducible masses" should be shown by ultrasound to determine whether cystic or solid sind.Warnzeichen The following findings are of particular importance: "Nonreducible mass", the normal spermatic cord structures hidden mass that is part of the testicles or adjacent to and ultrasound echogenic represents. An interpretation of the findings "nonreducible mass" that covers normal spermatic cord structures indicates an incarcerated hernia. When a mass is part of the testes or adjacent to, testicular cancer is possible. Other clinical features can give important information (see table: causes a painless scrotal mass). For example, a mass which can be represented by ultrasound, probably cystic (z. B. hydrocele, spermatocele). A mass that disappears when lying down or less, can varicocele, hernia or suspect "communicating hydrocele". The presence of a hydrocele makes the assessment of other scrotal masses from a study difficult. Rarely persists varicocele, when the patient is, or is present on the right side; each of these two findings suggests a obstruction of the inferior vena cava schliessen.Tests The clinical assessment may be diagnostically (e.g., with varicocele, lymphedema, hernia.); otherwise generally follow test procedures. An ultrasound is performed when the diagnosis is uncertain Normally when a hydrocele is present (to diagnose causative scrotal lesions) The mass display ultrasound is not If the ultrasound confirmed a solid mass of the testicles, further investigations with regard to testicular cancer conduct ( testicular tumor: diagnosis), including the following: ?-human chorionic gonadotropin levels (hCG) ?Fetoprotein mirror LDH levels CT of the abdomen therapy treatment depends on the particular cause. All patients should be treated. If a hernia is suspected, a reduction can be attempted (abdominal wall). Conclusion A "nonreducible mass" that covers normal spermatic cord structures indicates an incarcerated hernia. A solid mass and one that can not be represented by ultrasound, or both, to make a clarification with regard to testicular cancer required. The cause of hydrocele must be determined.