A discussion of the most important and common conditions that cause acute scrotal pain or swelling follows. Lumps in the groin and scrotum can occur at any age. Painless scrotal mass msd manual professional edition. A misleading erythema volume 20 supplement fabiana esposito, oliver sanchez, johan n.
Normally the testicle has a vertical lie within the tunica vaginalis of the scrotum that is, the longitudinal axis of the testis is oriented vertically. Although acute scrotal pain is a rare occurrence, it is important for the athletic trainer to recognize the common causes of the condition. What began as mild left scrotal discomfort is now causing increasing pain, swelling, hematuria, dysuria, lowgrade fever, and nausea, prompting him to seek medical attention. One of the main causes of painful scrotal swelling is testicular torsion.
A number of diagnoses can present with acute scrotal pain including testicular torsion and incarcerated inguinal hernia which require timecritical diagnosis to avoid permanent harm. Acute onset scrotal pain intermittent scrotal pain acute or intermittent abdominal pain testicular trauma. In this case, pain and swelling involve both the scrotal contents and the groin area. Acute management in the chw ed this document reflects what is currently regarded as safe practice. The term acute scrotum refers to acute scrotal pain with or without swelling and erythema. Epididymitisorchitis is rarely seen as a complication of hsp. Doppler ultrasound is not useful in the acute setting. Its diagnosis can prove challenging in both acute and chronic forms and requires a thorough and complete history and physical examination. However, as in any clinical situation, there may be factors which cannot be covered by a single set of guidelines. It may be either acute, subacute or chronic depending on its duration. Distinguish, through the history, physical examination and laboratory testing, testicular torsion, torsion of testicular appendices, epididymitis, testicular tumor, scrotal trauma, and hernia. Scrotal swellings are a common problem among men of all. Boys need to be educated about the phenomenon so that they report symptoms promptly. Chronic epididymitis lasts longer than three months and is usually characterized by.
Once a testicular torsion and incarcerated hernia has been excluded by surgical consultation, ultrasound may be considered if the diagnosis remains unclear. Initial evaluation and management of acute scrotal pain. Blunt injury eg, from an athletic accident or motor vehicle collision is the most common cause of scrotal trauma, followed by penetrating injury from. Most often swelling does not turn out to be cancer. An understanding of normal scrotal anatomy and the pathology of scrotal trauma, testicular torsion, torsion of a testicular appendage, and epididymitis are essential to provide a prompt initial evaluation.
Pdf acute scrotum is a surgical emergency which warrants immediate medical attention. A 32yearold man presents to the urgent care center at a community hospital with severe scrotal pain and swelling of five days duration. Because the testicular parenchyma cannot tolerate ischemia for more than a short time, testicular torsion must be ruled out rapidly as the cause 3, e1. It presents as scrotal swelling and skin color change, which mimics the presentations of testicular torsion, epididymitis, and testicular tumor.
Testicular pain is when part or all of either one or both testicles hurt. Acute scrotal pain and suspected testicular torsion. Radionuclide testicular scanning performed using technetium99m 99mtc. Sonography is the modality of choice for imaging the scrotum and determining the cause of acute scrotal swelling and. Diagnosis must be determined quickly and accurately to distinguish from a surgical emergency, such. An acute inguinal hernia may also present as an acute scrotum. Acute scrotal pain, once diagnosed, can be treated appropriately with either conservative or surgical measures. Learn vocabulary, terms, and more with flashcards, games, and other study tools. The patient should be asked about the exact temporal course of events, the intensity of the pain, and, in particular. Describe six conditions that may produce acute scrotal pain or swelling.
Acute idiopathic scrotal edema is selflimited, and treatment is conservative. Acute scrotum pain is defined as the constellation of newonset pain, swelling, andor tenderness of the intrascrotal contents. The complexity lies in the use of history, clinical examination and investigations in a restricted time frame, to identify the appropriate management path. Scrotal swelling in children american academy of pediatrics. Scrotal pain is a common complaint in a urological practice. Its differential diagnosis is important because scrotal involvement of acute pancreatitis can be treated conservatively.
Jul 02, 2019 scrotal swelling can happen rapidly or slowly over time. Acute scrotal pain emergency guideline childrens health. Table 531 lists the differential diagnoses for the acute scrotum. Lastly, scrotal edema secondary to hypoalbuminemia, portal hypertension and lymphadenopathy are also rare but significant conditions that. Testicular torsion accounts for about 25% cases of acute scrotum, with an. It is an important condition to recognize in order to. Acute idiopathic scrotal edema aise is a selflimiting condition characterized by marked edema of the skin and dartos fascia without involvement of the deeper layers, testes, or epididymis. Acute scrotal pain is a common surgical emergency in boys. Testicular or scrotal involvement has been reported in children with henochschonlein purpura and must be distinguished from testicular torsion. Left renal vein thrombosis can present with acute scrotal pain and a unilateral varicocoele. Epididymitis is the most common cause of acute scrotal pain among us adults, accounting for approximately 600,000 cases each year.
The testis, tunica vaginalis, epididymis, spermatic cord, appendix testis, and appendix epididymis are anatomic structures that may be involved in nonacute scrotal conditions. The most significant diagnosis to consider in a patient presenting with acute scrotal pain is that of torsion of the testis. Up to 25 % of the cases of the acute scrotum are caused by testicular torsion. This report highlights the role of complete decongestive therapy cdt in reducing edema and introduces the innovative and creative methods by which scrotal compression was achieved. Acute scrotal pain emergency management in children. Ultrasound doppler of a normal testis with extensive scrotal edema. This presentation should always be treated as an emergency because of the possibility of testicular torsion and permanent ischemic damage to the testis. The testis and epididymis also are palpated, and a penile examination is performed by the clinician.
Retinoic acid atra has been shown to improve survival in patients with acute promyelocytic leukemia apml. Scrotal swelling can happen rapidly or slowly over time. Any patient presenting with acute scrotal pain and a mass or swelling should be urgently evaluated for testicular torsion because timely diagnosis is key to. In any patient with loin pain, acute scrotal swelling and a varicocoele, evaluation of the abdomen and retroperitoneum for underlying malignancy and renal vein thrombosis should be considered.
This patient is a male in his 50s with a primary diagnosis of recurrent liposarcoma in the left groin and anterior hip capsule that required a left eh surgery with. Acute idiopathic scrotal edema radiology reference article. Pdf a clinicopathological study of acute scrotal swelling. Pdf role of us in acute scrotal pain carlo trombetta. Scrotal involvement is a rare complication of acute pancreatitis. Scrotal swelling caused by acute necrotizing pancreatitis. The estimated incidence of testicular torsion in adolescents is 1 per 4000, hence it is a common and serious condition. Jul 09, 2019 epidemiology of the acute scrotum in adolescents. Acute scrotal pain swelling this%information%sheet%is%for%educationalpurposes%only. Nonacute scrotal conditions in adults and scrotal disorders in children and. The overlying skin is examined to determine the extent of its integrity and for sites of any entry and exit wounds. Differential diagnosis of a scrotal mass wiley online library. However, colour doppler flow ultrasound can assess anatomy and blood flow. We report a case of a 5 year old boy diagnosed with henochschonlein purpura with acute scrotal swelling.
Usually arise suddenly with acute scrotal swelling and severe pain as blood supply to the testicles is interrupted. Research open access us in the assessment of acute. A painless scrotal mass is often noticed by the patient but may be an incidental finding on routine physical examination. Jun 22, 2012 the acute scrotum in childhood or adolescence is a medical emergency 1, 2. See evaluation of acute scrotal pain in adults and evaluation of nontraumatic scrotal pain or swelling in children and adolescents. Transillumination of the hydrocele, if positive, will establish the presence of fluid. This document was amended in july 2016 to reflect literature that. Available formats pdf please select a format to send. Medical conditions and diseases can also cause the scrotum to swell.
The acute scrotum is defined as scrotal pain, swelling, and redness of acute onset. Chronic scrotal pain pain for greater than 3 months may. Testicular swelling may be caused by orchitis, cancer, or testicular torsion. Scrotal ulceration during induction therapy of acute. We use cookies to make interactions with our website easy and meaningful, to better understand the use of our services, and to tailor advertising. Common causes of scrotal swelling by age infancy hydrocele. According to our definition, the term acute scrotum includes testicular torsion, orchitis, and epididymitis, or nontesticular diseases that can also present with acute painful swelling of the scrotum. Although these swellings are frequently encountered. Nonacute scrotal conditions in adults and scrotal disorders in children and adolescents are discussed separately. Men presenting with scrotal swelling should be evaluated for epididymitis, an acute inflammation of the epididymis which is usually a complication of gonococcal or chlamydial urethritis in men less than 35 years of age. Acute scrotal pain swelling monash childrens hospital. Acute scrotum is defined as the sudden onset of scrotal pain, which can be accompanied by swelling, erythema, and systemic signs of illness. Physical exam acute scrotal swelling with pain torsion of the testicle scrotal erythema swelling of the involved hemiscrotum higherthannormal position of the testis within the scrotum palpation may show a horizontal rather than normal vertical orientation of the testicle. This topic addresses the clinical evaluation and management of the acute scrotum, which is defined as moderate to severe scrotal pain that develops over the course of minutes to one to two days, in adults.
Clinical assessment is needed to detect those which need urgent investigation or treatment. This is an injury or an event that causes a testicle in the. Pdf role of us in acute scrotal pain carlo trombetta and. The diagnostic evaluation begins with historytaking. Man, 32, with severe scrotal pain and swelling clinician. Perhaps nausea and vomiting from the severity of the pain. The classic physical examination findings with testis torsion are an exquisitely tender testicle with a high, horizontal lie. But cancer of a testis is the most common solid cancer in men younger than 40 years and it also can occur in younger and older men, so any testicular swelling or lump should be checked by a doctor. Scrotal swellings enshrine clinical conditions affecting dermis and or subcutaneous tissue, and those of scrotal contents. They may cast a bluish hue to the overlying scrotal skin, especially in infants and younger children. Pain, scrotal swelling, and hydroceles occur when the inflammatory process spreads along tissue planes to the scrotum. Pdf scrotal swellings enshrine clinical conditions affecting dermis and or subcutaneous tissue, and those of scrotal contents. The acute scrotum per our previous definition can be quite common in adolescents.
Research open access us in the assessment of acute scrotum. Dec 05, 2011 physical exam acute scrotal swelling with pain torsion of the testicle scrotal erythema swelling of the involved hemiscrotum higherthannormal position of the testis within the scrotum palpation may show a horizontal rather than normal vertical orientation of the testicle. Cancer of a testis is the most concerning cause of painless scrotal swelling. Acute idiopathic scrotal edema radiology reference. They may respond to hormones by increasing in size in the years before puberty. The acute care management of scrotal edema statuspost. Appropriately order imaging studies to make the diagnosis of the acute. Testicular torsion is the most serious condition that presents with an acute scrotum. Jul 27, 2010 scrotal involvement is a rare complication of acute pancreatitis. Diagnosis for scrotal swellings how do i identify the cause in a boy or man with a scrotal swelling. The differential diagnosis includes torsion, infection, trauma, tumor, and rarer causes. Chronic scrotal pain pain for greater than 3 months may occur due to a number of underlying conditions.
Incidence of testicular torsion has a bimodal age distribution, occurring in neonates, adolescents and young adults. Lastly, scrotal edema secondary to hypoalbuminemia, portal hypertension and lymphadenopathy are also rare but significant conditions that may occur under the aegis of the acute scrotum. Hydroceles are easily recognized as swelling in the scrotum, either unilaterally or bilaterally table 1. A clear cut insight into their symptoms and signs are imperative to. Dryness of the skin, cheilitis, and xerostomia are the common mucocutaneous side effects. Have a very low threshold for suspecting testicular torsion in a boy or man presenting with acute, painful scrotal swelling, particularly if he is younger than 30 years of age. Abdominopelvic ct provides a useful means of diagnosing this. The acute scrotum in childhood or adolescence is a medical emergency 1, 2. While it usually occurs in postpubertal boys, it can be seen in a range of ages from neonates to young men. Acute scrotal swelling is a rare complication of acute pancreatitis. Slow to resolve may have weeks of gradually subsiding scrotal discomfort and swelling. Treatment of the underlying, nonscrotal cause is most effective to relieve the scrotal symptoms. The acute scrotum is defined as scrotal pain, swelling, and redness of acute onset figure 1.
It is caused by pancreatic enzymes leaking from damaged pancreatic tissue into the scrotum via the inguinal canal or body wall. Usually a working diagnosis can be made clinically, and ultrasound is often helpful. Idiopathic scrotal edema and filarial infections rare in the us can also cause chronic, relatively painless, scrotal swelling. This guideline has been adapted for statewide use with the support of the victorian paediatric clinical network. Siebert, sergio manzano skip to main content accessibility help we use cookies to distinguish you from other users and to provide you with a better experience on our websites. This article discusses the evaluation and management. Scrotal pain and painful scrotal masses or swelling can be caused by testicular torsion, appendiceal torsion, epididymitis, epididymoorchitis, scrotal abscess, trauma, strangulated inguinal hernias, orchitis, and. Extension of the infection to involve the adjacent testicle results in epididymoorchitis.
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