CASE # 3Amaro.Amolenda.Anacta

Case #3

A 35-year old male comes to your clinic with the following problem of 10 years duration. Except for the mass, he is relatively asymptomatic.

Differential Diagnosis

HYDROCELE Collection of serous fluid that results from a defect or irritation in

the tunica vaginalis of the scrotum Adult hydroceles are usually late-onset (secondary). Late-onset

hydroceles may present acutely from local injury, infections, and radiotherapy; they may present chronically from gradual fluid accumulation. Morbidity may result from chronic infection after surgical repair. Hydrocele can adversely affect fertility.

Clinical Manifestation:• Most hydroceles are asymptomatic or subclinical*• The patient may report a sensation of heaviness, fullness, or

dragging.

Differential Diagnosis

TESTICULAR TORSION Testicular torsion occurs when a testicle rotates on the

spermatic cord, which provides blood flow to the testicle* Testicular torsion is most common in males under 25, but

it can occur at any age, including in newborns and infants.

Clinical Manifestation:• Sudden or severe pain in one testicle • Swelling of the scrotum (a loose bag of skin under your penis that

contains your testicles) • Nausea and vomiting • Abdominal pain • Fever

Differential Diagnosis

ORCHITIS Orchitis is an acute inflammatory reaction of the testis

secondary to infection. Most cases are associated with a viral mumps infection; however, other viruses and bacteria can cause orchitis.

Clinical Manifestation:• Testicular swelling on one or both sides • Pain ranging from mild to severe • Tenderness in one or both testicles • Nausea • Fever • Discharge from penis • Blood in semen

Differential Diagnosis

INGUINAL HERNIA Inguinal hernias occur when soft tissue,

usually part of the intestine protrudes through a weak point or tear in the lower abdominal wall. *

Some inguinal hernias have no apparent cause. But many occur as a result of: (1) Increased pressure within the abdomen, (2) A pre-existing weak spot in the abdominal wall, (3) A combination of the two*

Differential Diagnosis

Clinical Manifestation A bulge in the area on either side of your

pubic bone Pain or discomfort in your groin, especially

when bending over, coughing or lifting A heavy or dragging sensation in your groin Occasionally, in men, pain and swelling in the

scrotum around the testicles when the protruding intestine descends into the scrotum

Initial AssessmentLate-Onset Hydrocele

DIAGNOSIS

Physical Examination

Enlarged, non tender scrotum Testicles cannot be palpated If there’s an associated inguinal hernia,

pressure on the abdomen or scrotum will enlarge or shrink the fluid-filled sac

Transillumination shine a flashlight at the swollen area of the

scrotum the light will show the outline of the testicle,

indicating a clear fluid surrounding it

Ultrasound

often used to confirm the diagnosis of hydrocele as it provides excellent detail of the testicular parenchyma

rule out a tumor, torsion, spermatocele or other conditions

if a testicular tumor is a diagnostic consideration, ultrasonography is an excellent screening study

Ultrasound of Hydrocele

Plain abdominal radiography

Plain radiography may be useful for distinguishing an acute hydrocele from an incarcerated hernia

Gas overlying the groin may indicate an incarcerated hernia.