Some Causes of a Painless Scrotal Mass
Cause | Suggestive Findings | Diagnostic Approach |
|---|---|---|
Hydrocele (communicating) usually in patients with inguinal hernias | Cystic swelling Increase in size when upright or when intra-abdominal pressure increases Usually congenital Transilluminates | Clinical evaluation Ultrasonography if diagnosis is uncertain |
Hydrocele (noncommunicating) | Cystic swelling Does not change in size with changes in position of intra-abdominal pressure Often a simultaneous scrotal abnormality (eg, tumor, epididymitis) Transilluminates | Clinical evaluation Usually ultrasonography |
Spermatocele | Cystic mass at the upper pole of the testis, adjacent to epididymis Transilluminates | Clinical evaluation Ultrasonography if diagnosis is uncertain |
Inguinal hernia | Increases in size when upright or when intra-abdominal pressure increases May disappear when recumbent or be reducible or compressible Possibly bowel sounds Absence of normal spermatic cord structures above the mass Possibly palpable in the inguinal canal | Clinical evaluation |
Varicocele | Palpable when standing (enhanced with Valsalva), feeling like a bag of worms Usually on left side Possibly pain and fullness when standing Possibly testicular atrophy | Clinical evaluation |
Hematocele | Tender swelling Risk factors (eg, trauma, surgery, bleeding disorder or use of anticoagulants) | Usually ultrasonography |
Fluid overload | Diffuse, bilateral enlargement of scrotal sac Often pitting edema of lower extremities Often causative disorder evident (eg, heart failure, ascites, nephrotic syndrome) Transilluminates | Clinical evaluation Ultrasonography if diagnosis is uncertain |
Lymphedema (eg, from filariasis, congenital, idiopathic, after pelvic radiation or cancer [eg, prostate, bladder, testicular]) | Diffuse scrotal swelling Often nonpitting | Clinical evaluation Imaging (CT/ultrasonography) if diagnosis is uncertain |
Testicular cancer and other malignancies such as lymphoma | Mass attached to or part of testis Is solid or does not transilluminate Possibly dull, aching pain or acute pain due to hemorrhage | Ultrasonography of scrotum Alpha-fetoprotein Beta-human chorionic gonadotropin Lactic dehydrogenase CT of the abdomen |