Diagnosis of Autoimmune orchitis
Autoimmune orchitis Diagnosis: Book Excerpts
Diagnostic Tests for Autoimmune orchitis: Online Medical Books
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TESTICULAR ATROPHY:
Ask the Following Questions:
(Algorithmic Diagnosis of Symptoms and Signs)
- Is it unilateral? The presence of unilateral atrophy would suggest hernia surgery, previous orchitis from mumps, gonorrhea, syphilis, tuberculosis or elephantiasis, varicocele, hydrocele, and an undescended testicle.
- Is there a history of trauma or surgery? A history of surgery would suggest that the testicular atrophy is related to hernia surgery or surgery for undescended testicle, vasectomy, or prostatectomy. History of trauma may suggest that the patient had an acute orchitis or hemorrhage from trauma.
- Is there a history of an infection? A history of infection would suggest mumps, gonorrhea, syphilis, tuberculosis, or elephantiasis.
- Is there a loss of secondary sex characteristics? These findings would suggest Klinefelter's syndrome.
- Is there an enlarged liver? The presence of an enlarged liver or other signs of hepatic dysfunction would suggest cirrhosis or hemochromatosis.
- Are there abnormal neurologic findings? The presence of abnormal neurologic findings would suggest myotonia atrophica.
DIAGNOSTIC WORKUP
Unilateral testicular atrophy usually requires no workup as long as there are no complaints of sexual infertility or impotence. A smear and culture of any urethral discharge should be done. Sometimes, prostatic massage may be necessary to obtain a good specimen.
The workup of bilateral testicular atrophy may include a serum testosterone, FSH, urine gonadotrophins, and chromosome studies to rule out Klinefelter's syndrome; liver function tests and liver biopsy to rule out cirrhosis and hemochromatosis; and EMG and muscle biopsies to rule out myotonia atrophica. A testicular biopsy may be necessary ultimately. A urologist will be consulted long before most of these tests would be performed.
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Source: Algorithmic Diagnosis of Symptoms and Signs, 2003
TESTICULAR SWELLING:
Ask the Following Questions:
(Algorithmic Diagnosis of Symptoms and Signs)
- Is there pain or tenderness of the testicle? The presence of pain or tenderness should suggest torsion of the testicle, orchitis, epididymitis, and a strangulated inguinal hernia.
- Is the testicle retracted or does elevation of the testicle aggravate the pain? These findings would suggest torsion of the testicle.
- Does the swelling transilluminate? If the swelling transilluminates, the mass or swelling is most likely a hydrocele or spermatocele.
- Is the swelling reducible? If the swelling is reducible, the mass is probably an inguinal hernia or varicocele. A mass that does not reduce could still be an incarcerated inguinal hernia.
DIAGNOSTIC WORKUP
A CBC, sedimentation rate, urinalysis, chemistry panel, and VDRL test should be done routinely. If a tumor of the testicle is suspected, 24-hr urine gonadotrophins and alpha-fetoprotein levels may be ordered. If there is a urethral discharge, a smear and culture should be done. If a hernia is strongly suspected, a general surgeon should be consulted. Testicular scans with technetium-99m will help distinguish torsion of the testicle from orchitis or epididymitis. Scrotal ultrasound may be useful in differentiating a hematoma, abscess, or rupture from orchitis. It may also be helpful in evaluating testicular tumors. CT scan of the abdomen and pelvis may be necessary to rule out metastasis.
The expense of some or all of these tests may be avoided by consulting a urologist early in the diagnostic workup.
» READ BOOK EXCERPT ONLINE »
Source: Algorithmic Diagnosis of Symptoms and Signs, 2003
Testicular Pain:
Differential Diagnosis
(In a Page: Signs and Symptoms)
-
Epididymitis
–Insidious onset of symptoms seen in adolescent (postpuberty) boys
–Bacterial (e.g., Chlamydia, Enterobacter) versus viral (mumps, mononucleosis, adenovirus) -
Testicular torsion
–Twisting of the spermatic cord results in testicular ischemia
–Acute onset of severe pain, diffuse tenderness
–Negative urinalysis; absent cremasteric reflex
–Testes on affected side are tender, shortened, and lie transversely
–Duration of ischemia (time until detorsion is completed) determines the viability of the affected testicle
-
Hydrocele
–A collection of fluid between the layers of the tunica vaginalis; usually nontender
-
Varicocele
–Palpated as a “bag of worms” above testes
–Dull ache exacerbated by strenuous
exercise; left >right
-
Epididymal or testicular appendage torsion
–Subacute onset seen in prepubertal boys
–Localized to the upper pole of testicle
–Negative U/A; normal cremasteric reflex
-
Ruptured abdominal aortic aneurysm
-
Peritonitis
-
Referred pain due to an incarcerated hernia, constipation, or kidney stone
-
Scrotal trauma
–Results from a direct blow or saddle injury
–May result in traumatic epididymitis,
hematocele, or laceration of the tunica albuginae (testicular rupture)
-
Fournier's gangrene
–Necrotizing fasciitis of the perineum
–Seen primarily in older men - Henoch-Schönlein purpura
–Systemic vasculitis resulting in scrotal pain, abdominal pain, arthralgias, nonthrombocytopenic purpura, and renal disease
–Occurs in prepubertal boys - Tumor
–Painless scrotal mass is a testicular
neoplasm until proven otherwise
Workup and Diagnosis
- History and physical examination including abdomen, back, genitalia, and digital rectal examination
–Note character of onset (sudden or subacute), duration (minutes, hours, or days), location (generalized or localized), quality (sharp or dull, moderate or severe, constant or intermittent), and previous episodes
–Palpate testicle and spermatic cord to assess for tenderness, effusion, subcutaneous emphysema, size, and lie of testicle, and assess for hernias
–Transilluminate for presence of fluid
–“Blue dot sign”: Bluish discoloration along upper pole seen in about 20% of cases of torsion of the testicular appendix and due to infarction and necrosis
–“Prehn's sign”: Relief of pain with elevation of the testis in testicular torsion
-
If testicular torsion is suspected, emergent detorsion is necessary, generally by a urologic specialist
-
Culture for Neisseria gonorrhoeae and Chlamydia trachomatis in sexually active males before urinalysis
-
Urinalysis in all patients: Elevated WBC or RBC levels suggest infection (e.g., epididymitis)
-
Ultrasound of the testicles using color Doppler measures blood flow and evaluates for masses
-
Radionucleotide scintigraphy may also be used to assess blood flow
-
Recent studies have advocated the use of MRI
» READ BOOK EXCERPT ONLINE »
Source: In a Page: Signs and Symptoms, 2004
TESTICULAR ATROPHY:
Approach to the Diagnosis
(Differential Diagnosis in Primary Care)
The workup of testicular atrophy may require a chromatin analysis, serum testosterone, FSH and LH levels, and biopsy, but referral to an endocrinologist is the best way to get this accomplished with accuracy.
» READ BOOK EXCERPT ONLINE »
Source: Differential Diagnosis in Primary Care, 2007
TESTICULAR MASS:
Approach to the Diagnosis
(Differential Diagnosis in Primary Care)
Testicular masses may be differentiated by transillumination (hydroceles and spermatoceles transilluminates, whereas hernias and tumors do not). Hernias may also be differentiated by reducing them (some will not reduce, however, if they are incarcerated) and auscultation may reveal bowel sounds. In noncommunicating hydroceles and testicular tumors, one may get above the swelling, whereas in torsion and hernias one cannot. In torsion, the tenderness is increased by elevation of the testicle, whereas in orchitis the tenderness is relieved if elevation is done for an hour or more. Surgery may be the only way to differentiate the cause of the mass.
» READ BOOK EXCERPT ONLINE »
Source: Differential Diagnosis in Primary Care, 2007
TESTICULAR PAIN:
Approach to the Diagnosis
(Differential Diagnosis in Primary Care)
The approach to the diagnosis of testicular, pain involves searching for a mass; if it is present, certain questions must be answered. Does it transilluminate (hydrocele)? Can one get above the swelling (testicular mass)? Is it reducible (hernia)? Does supporting the testicle relieve the pain (torsion)? A search for prostatic hypertrophy or prostatitis should be made, particularly in older men. Smears of urethral discharge, urinalysis and urine culture, cystoscopy, and an IVP may be indicated in selected cases. An exploration for torsion or hernia may be the only way to establish these diagnoses.
» READ BOOK EXCERPT ONLINE »
Source: Differential Diagnosis in Primary Care, 2007
Testicular cancer:
Diagnosis
(Professional Guide to Diseases (Eighth Edition))
Two effective means of detecting a testicular tumor are regular self-examinations and testicular palpation during a routine physical examination. Transillumination can distinguish between a tumor (which doesn't transilluminate) and a hydrocele or spermatocele (which does). Follow-up measures should include an examination for gynecomastia and abdominal masses.
Diagnostic tests include excretory urography to detect ureteral deviation resulting from para-aortic node involvement, urinary or serum luteinizing hormone levels, blood tests, lymphangiography, ultrasound, and abdominal computed tomography scan. Serum alpha-fetoprotein and beta-human chorionic gonadotropin levels — indicators of testicular tumor activity — provide a baseline for measuring response to therapy and determining the prognosis.
Surgical excision and biopsy of the tumor and testis permits histologic verification of the tumor cell type — essential for effective treatment. Inguinal exploration determines the extent of nodal involvement. (See Staging testicular cancer.)
» READ BOOK EXCERPT ONLINE »
Source: Professional Guide to Diseases (Eighth Edition), 2005
Testicular torsion:
Diagnosis
(Professional Guide to Diseases (Eighth Edition))
Physical examination reveals tense, tender swelling in the scrotum or inguinal canal and hyperemia of the overlying skin. Doppler ultrasonography helps distinguish testicular torsion from strangulated hernia, undescended testes, or epididymitis.
» READ BOOK EXCERPT ONLINE »
Source: Professional Guide to Diseases (Eighth Edition), 2005
Testicular cancer:
Diagnosis
(Handbook of Diseases)
❑ Two effective means of detecting a testicular tumor are regular self-examinations and testicular palpation during a routine physical examination.
❑ Transillumination can distinguish between a tumor (which doesn’t transilluminate) and a hydrocele or spermatocele (which does). Follow-up measures should include an examination for gynecomastia and abdominal masses.
❑ Diagnostic tests include excretory urography to detect ureteral deviation resulting from para-aortic node involvement, urinary or serum luteinizing hormone levels, ultrasound, and abdominal computed tomography scan.
Serum alpha-fetoprotein and beta-human chorionic gonadotropin levels, indicators of testicular tumor activity, provide a baseline for measuring response to therapy and determining the prognosis.
❑ Surgical excision and biopsy of the tumor and testis permits histologic verification of the tumor cell type — essential for effective treatment. Inguinal exploration determines the extent of nodal involvement.
» READ BOOK EXCERPT ONLINE »
Source: Handbook of Diseases, 2003
Chronic fatigue and immune dysfunction syndrome:
Diagnosis
(Handbook of Diseases)
The cause and nature of CFIDS are still unknown, and no single test unequivocally confirms its presence. Therefore, the diagnosis is based on the patient’s history and the CDC criteria. Because the CDC criteria are admittedly a working concept that may not include all forms of this disease and are based on symptoms that can result from other diseases, diagnosis is difficult and uncertain. Considerable overlap exists between CFIDS and fibromyalgia syndrome, with many patients having features of both.
» READ BOOK EXCERPT ONLINE »
Source: Handbook of Diseases, 2003
TESTICULAR ATROPHY:
Approach to the Diagnosis
(Differential Diagnosis in Primary Care)
The workup of testicular atrophy may require a chromatin analysis,
serum testosterone, follicle-stimulating hormone (FSH) and luteinizing
hormone (LH) levels, and biopsy, but referral to an endocrinologist is the
best way to get this accomplished with accuracy.
» READ BOOK EXCERPT ONLINE »
Source: Differential Diagnosis in Primary Care, 2007
TESTICULAR MASS:
Approach to the Diagnosis
(Differential Diagnosis in Primary Care)
Testicular masses may be differentiated by transillumination
(hydroceles and spermatoceles transilluminate, whereas hernias and tumors do
not). Hernias may also be differentiated by reducing them (some will not
reduce, however, if they are incarcerated), and auscultation may reveal
bowel sounds. In noncommunicating hydroceles and testicular tumors, one may
get above the swelling, whereas in torsion and hernias one cannot. In
torsion, the tenderness is increased by elevation of the testicle, whereas
in orchitis the tenderness is relieved if elevation is done for an hour or
more. Serum alpha-fetoprotein beta-human chorionic gonadotropin (HCG) or
lactic dehydrogenase (LDH) will be elevated in testicular
tumors. Surgery may be the only way to differentiate the cause of the mass.
» READ BOOK EXCERPT ONLINE »
Source: Differential Diagnosis in Primary Care, 2007
TESTICULAR PAIN:
Approach to the Diagnosis
(Differential Diagnosis in Primary Care)
The approach to the diagnosis of testicular pain involves searching for
a mass; if it is present, certain questions must be answered. Does it
transilluminate (hydrocele)? Can one get above the swelling (testicular
mass)? Is it reducible (hernia)? Does supporting the testicle relieve the
pain (torsion)? A search for prostatic hypertrophy or prostatitis should be
made, particularly in older men. Smears of urethral discharge, urinalysis
and urine culture, cystoscopy, and an intravenous pyelogram (IVP) may be
indicated in selected cases. An exploration for torsion or hernia may be the
only way to establish these diagnoses.
» READ BOOK EXCERPT ONLINE »
Source: Differential Diagnosis in Primary Care, 2007
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