Differentials
Inguinal hernia
SIGNS / SYMPTOMS
An incarcerated inguinal hernia may be difficult to distinguish from a hydrocele.
INVESTIGATIONS
A groin ultrasound will show abnormal ballooning of the anteroposterior diameter of the inguinal canal. Occasionally, a segment of omentum (fat) or a segment of the bowel is seen.
Testicular cancer
SIGNS / SYMPTOMS
These will usually be solid, firm masses that are not transilluminated. However, tumours may have reactive hydroceles surrounding them, and these will be transilluminated.
INVESTIGATIONS
Scrotal ultrasound will confirm the diagnosis.[27] Testicular tumour markers, such as alpha-fetoprotein or beta-hCG, may also be used to indicate tumour activity.
Epididymitis
SIGNS / SYMPTOMS
Clinically the patient has pain and tenderness in the scrotum, and local inflammatory changes can be seen.
INVESTIGATIONS
Colour Doppler ultrasonography may help confirm the diagnosis.[28]
Epididymo-orchitis
SIGNS / SYMPTOMS
Scrotal tenderness and swelling. Clinically, the patient has pain and tenderness in the scrotum, and local inflammatory changes can be seen.
INVESTIGATIONS
Color Doppler ultrasonography will confirm the diagnosis.[28]
Epididymal cyst
SIGNS / SYMPTOMS
Scrotal mass that can be transilluminated. The position of the cyst helps the diagnosis. The cyst can be palpated separately from the testis, lying posterior and superior to it.[29]
INVESTIGATIONS
Scrotal ultrasound may assist in making the diagnosis.
Scrotal oedema
SIGNS / SYMPTOMS
Thickening of the scrotal wall.
INVESTIGATIONS
Diagnosis is best made by scrotal examination. Scrotal ultrasound may be beneficial.[27]
Testicular torsion
SIGNS / SYMPTOMS
Extreme tenderness, elevation of the testis, loss of landmarks, and absence of a cremasteric reflex are characteristic signs of torsion.
Varicocele
SIGNS / SYMPTOMS
Palpation of enlarged veins during Valsalva manoeuvre is diagnostic on physical examination.
INVESTIGATIONS
Physical examination is diagnostic, but orchidometer, ultrasound, or colour Doppler ultrasonography can be used for confirmation and to determine testicular size.[19]
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