‘TesticularMass

Differential diagnosis includes painful etiologies (testicular torsion, torsion of testicular appendage, epididymitis) and painless etiologies (hydrocele, varicocele, spermatocele, inguinal hernia, testicular cancer)

Painful Etiologies
- If painful determine TWIST score (2 pts testicular swelling, 2 pts testicular hardness, 1 pt N/V, 1 pt high riding testicle)
    - If 5 or greater obtain urgent urologic consultation
    - If 3-4 obtain doppler U/S and urologic consultation
    - If 0-2 low risk, consider imaging
- *Testicular torsion is diagnosed via doppler U/S and treated with bilateral orchiopexy
- *Torsion of testicular appendage is painful with a rarely associated “blue dot sign” noted on scrotum. May require surgery to diagnose and treated with analgesics
- *Epididymitis is inflammation, often bacterial, of the epididymis. In sexually active individuals, often gonorrhea/chlamydia, requiring treatment with 1 IM dose Rocephin and 10 days doxycycline. If enteric, non-sexually active men, treat with Levofloxacin. In men who have sex with men treatment is 1 IM dose Rocephin and Levofloxacin.

Painless Etiologies
- *Hydrocele is a fluid collected in the scrotum, noted to transilluminate with flashlight. Often seen in 1st year of life and will self-resolve. May be associated with undescended testicle or inguinal hernia
- *Varicocele is noted as a “scrotal heaviness” or a “bag of worms” in the scrotum. Often on left side over right due to draining into L renal vein. Enlarges with Valsalva and shrinks with lying supine. Often no treatment required.
- *Spermatocele is a cystic fluid collected on head of epididymis with no changes based on position.
- *Inguinal hernia, determined by mass palpated in inguinal canal on Valsalva
- *Testicular cancer should be suspected for solid testicular mass. Obtain U/S and consider LDH, AFP, beta-hCG