TESTICULAR SWELLING

TESTICULAR SWELLING: Excerpt from Algorithmic Diagnosis of Symptoms and Signs

Ask the Following Questions:

1. 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.
2. Is the testicle retracted or does elevation of the testicle aggravate the pain? These findings would suggest torsion of the testicle.
3. Does the swelling transilluminate? If the swelling transilluminates, the mass or swelling is most likely a hydrocele or spermatocele.
4. 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.

Book Source Details

• Book Title: Algorithmic Diagnosis of Symptoms and Signs
• Author(s): R. Douglas Collins
• Year of Publication: 2003
• Copyright Details: Algorithmic Diagnosis of Symptoms and Signs, Copyright © 2003 Lippincott Williams & Wilkins.

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Copyright notice for book excerpts: Copyright © 2008 Lippincott Williams & Wilkins. All rights reserved.

More About This Book: Title: Algorithmic Diagnosis of Symptoms and Signs Authors: R. Douglas Collins Publisher: Lippincott Williams & Wilkins Copyright: 2003 ISBN: 0-7817-3805-9

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