SA Medical - General Medicine And Imaging of Disease

Inguinal hernia, hydrocele, epididymal cyst, testicular tumour, varicocele, sebaceous cyst, tuberculous epididymo-orchitis, gumma of the testis, carcinoma of scrotal skin. Determining the diagnosis Inguinal hernia An indirect inguinal hernia often extends into the scrotum. It usually has a cough impulse (i.e. it expands on coughing) and usually reduces with direct pressure or on lying down. It is not possible to get above the lump. Hydrocele A hydrocele is an abnormal quantity of peritoneal fluid between the parietal and visceral layers of the tunica vaginalis, the double layer of peritoneum surrounding the testis and which was the processus vaginalis in the fetus. Normally the processus vaginalis becomes obliterated along its entire length, apart from where it surrounds the testis where a potential space remains between the parietal and visceral layers. Usually painless, unless the underlying testicular disease is painful. A hydrocele has a smooth surface and it is difficult or im...

Scrotal pain Pathology within the scrotum Torsion of the testicles  Torsion of testicular appendages Epididymo-orchitis Testicular tumour Referred pain Ureteric colic Testicular torsion: ischaemic pain is severe (e.g. myocardial infarction, ischaemic leg, ischaemic testis). Torsion presents with sudden onset of pain in the hemiscrotum , sometimes waking the patient from sleep. May radiate to the groin and/or loin. There is sometimes a history of mild trauma to the testis in the hours before the acute onset of pain. Similar episodes may have occurred in the past, with spontaneous resolution of the pain (suggesting torsion/spontaneous detorsion). The testis is very tender. It may be high-riding (lying at a higher than normal position in the testis) and may lie horizontally due to twisting of the cord. There may be scrotal erythema. Epididymo-orchitis: similar presenting symptoms as testicular torsion. Tenderness is usually localized to the epididymi...