clinical features

Last reviewed 01/2018

Scrotal mass may present as an acute scrotal swelling or as a non acute scrotal swelling. Some common causes are mentioned below (1).

Acute scrotal swelling

  • testicular torsion
    • there is severe pain which begins suddenly (except in neonates) (1), may radiate to inguinal and hypogastric areas (4)
    • nausea, vomiting, and a low-grade fever may follow pain (2)
    • presents with a tender testis and testis is often elevated in the scrotum and may have an abnormal lie (transverse lie) (3)
    • in newborns often there is discoloration and a hard painless mass in the scrotum on the affected side (2)
    • cremasteric reflex is usually not seen (3)
    • elevation of the scrotum does not relieve the pain (2)
  • epididymitis/epididymo-orchitis
    • presents with subacute onset of pain and swelling (4)
    • epididymis can be felt separately from the testis as a tender enlarged structure (2)
    • pain is relieved when the testis is elevated - useful in differentiating epididymitis from torsion of the spermatic cord (2)
    • often seen together with symptoms of urinary tract infection and prostitis (1)
  • trauma
  • torsion of appendix testis/appendix epididymis
    • pain may develop gradually or acutely (1)
    • cremasteric reflex is present
    • a small hard nodule can be felt on the superior aspect of the testis
    • often there is bluish discolouration seen through the skin - "blue dot" sign (2)
  • inguinal hernia
    • patient presents with pain and swelling (1)
    • may enlarge with Valsalva maneuver
    • reducible (unless incarcerated) (4)
    • bowel sounds on affected side may be heard (2)

Nonacute scrotal swelling

  • hydrocele
    • onset may be acute or insidious
    • appears as painless unilateral scrotal swelling
    • it is fluctuant, ovoid, and nontender
    • transillumination is present (4)
  • varicocele
    • chronic onset
    • asymptomatic or may present with a dull, dragging discomfort on the affected side
    • may present with 'bag of worms' consistency (4)
    • seen when standing and disappears on lying down (1)
  • spermatocele
    • soft nodule located in the epididymal head
    • swelling felt superior and posterior to the testes
    • does not transilluminte (4)
  • epidermoid cyst
    • non tender, palpable mass (2)
  • tumor
    • usually painless but around 10% may have acute pain due to bleeding inside the tumor or associated epididymitis (5)
    • enlarged, nontender, firm mass
    • does not transilluminate (4)

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