swelling of the scrotum
Introduction
Introduction Scrotal swelling refers to the scrotum wall or sheath testis, epididymis and spermatic cord and other scrotal contents, due to acute and chronic inflammation, parasitic invasion, and its own organic changes in tumors can cause pathological swelling of the scrotum, or inflammatory infiltration Increased, edematous effusion If the peritoneal sheath is not closed or not fully closed after birth, the contents of the abdominal cavity can go to the scrotum. Physical examinations such as medical history and local palpation test can determine the location and nature of the scrotal enlargement and make a correct diagnosis.
Cause
Cause
The cause of swelling of the scrotum:
According to the lesions that cause swelling of the scrotum, it can be divided into three categories:
(1) scrotal wall lesions: such as sac wall edema, scrotal wall hematoma, scrotum wall cutaneous swelling, erysipelas skin gangrene, cellulitis, urinary extravasation scrotal wall benign tumor (serolipoma, hemangioma X scrotum wall Malignant tumor.
(B) the lesions of the scrotum inclusions:
1. Sheath: hydrocele, hydrocele, hydrocele, and hydrocele.
2. Epididymis: acute and chronic epididymitis, epididymal tuberculosis, epididymis, blood stasis after stasis, semen cyst.
3. Testicles: Testicular inflammation Testicular tuberculosis, testicular syphilis. Testicular tumors.
4. spermatic cord: spermatic sphincter hydrocele, varicocele, spermatic cord to reverse the spermatic sheath cyst, spermatic cord blood nodule, spermatic cord hematoma sterilization after vas deferens nodules, sterilization After sperm granuloma.
(C) the contents of the abdominal cavity into the scrotum: such as ascites or inguinal hernia content (small intestine bladder, omentum, etc.) into the scrotum.
Examine
an examination
Related inspection
Scrotal examination of scrotum ultrasound
Examination and diagnosis of scrotal swelling:
First, the medical history: a detailed inquiry about the history of scrotal enlargement is very important for diagnosis and differential diagnosis. The main course should be to ask about the course of scrotal enlargement, local symptoms and symptoms of the whole body or other systems.
1. The length of the disease course: Infectious scrotal swelling often begins with a sudden onset; the course of hydrocele is slow and often prolonged for several years; testicular tumors generally have a shorter course of disease; elephant swelling has a long history of contact with water, showing progressive development Most of the scrotal cysts caused by inguinal hernia vary with intra-abdominal pressure, and are large and small.
2. Local symptoms: Infectious scrotal cysts are mostly accompanied by redness, heat, pain and other symptoms; testicular or attached tumors often have falling pain; like skin edema often secondary infection due to eczema or ulcers.
3. Systemic or other systemic symptoms: Scrotal swelling with systemic fever, such as epidemic mumps complicated with acute orchitis; epididymal tuberculosis may be accompanied by urinary frequency, urgency, dysuria and other symptoms of urinary tuberculosis.
Second, physical examination:
1. Local palpation: Local palpation is the most important and simple method for diagnosing scrotal enlargement. The scrotum and its contents belong to the external genital organs. The examiner must be familiar with the general anatomy of the contents of the scrotum in order to clearly diagnose the lesion. The scrotum is still the skin of the scrotum; it is the original scrotum content, or from the groin area; is the testicular enlargement, or the epididymis enlargement; is cystic enlargement or substantial enlargement...... During the examination, the patient should take the standing first, and then the person who is in the position examination and check the hands at the same time is helpful for comparison.
2. Cough impact: The inguinal herd and hydrocele were identified by cough impact test on the mass from the abdominal muscle sulcus.
3. Light transmission test: It is of great value for identifying whether the scrotal enlargement is cystic or substantial.
4. Scrotal puncture: In order to identify the nature of the scrotal effusion, puncture and drainage can be performed, but for the substantial enlargement, the tissue can be aspirated for pathological examination.
5. Other examinations: including abdominal examination of the prostate examination and related general examination.
Third, the laboratory examination: hematuria routine and erythrocyte sedimentation test have certain auxiliary diagnostic significance in acute and chronic infection; blood smear microscopic butterfly to find the diagnostic value of the diagnosis of scrotal elephant skin swelling; determination of blood or urine human fluff Membrane gonadotropin (HCG) and alpha-fetoprotein (AFG) are important for the diagnosis of testicular choriocarcinoma or embryonal cancer.
Fourth, imaging diagnosis: mainly by ultrasound Doppler ultrasonography, radionuclide gamma angiography, infrared scrotum temperature recording method (Scrotalthenngraphy) and other comprehensive diagnostic ideas.
Diagnosis
Differential diagnosis
Differential diagnosis of scrotal swelling:
First, the scrotal wall lesions:
1. Scrotal edema: due to scrotal allergy (worm bite angioedema) inflammation, contusion, tumor compression of the inferior vena cava or systemic diseases (such as heart failure nephrotic syndrome, high ascites, cachexia, etc.) lead to accumulation of scrotal wall tissue Excessive water showed that the scrotum was obviously swollen, the wrinkles disappeared, and the translucent and shiny pressure had obvious depression and no tenderness. If accompanied by inflammation, there may be tenderness and congestion.
2. Scrotal elephant skin swelling: This is a clinical manifestation of urogenital filariasis. The parasitic blood worms block the scrotum and its nearby lymphatic vessels. The lymphatic drainage is blocked and overflows, which stimulates the proliferation of fibrous tissue in the scrotum and subcutaneous. Causes swelling of the elephant. The performance of the scrotal skin is rough, the cortex and subcutaneous tissue is extremely thick and pressure is not easy to appear depression, the penis skin is often involved, so that the penis is invaded and another kind is due to lymphatic deposition, making the scrotum skin moist, and severe cases can be seen Lymph fluid can continue to be infected, and acute lymphangitis such as ulcers and eczema is often accompanied by fever and local swelling and pain. This disease is common in the epidemic area of filariasis, and the surrounding blood samples can be found at night to find microfilaments.
3. Erysipelas: Due to the inflammatory lesions of the lymphatic scrotum on the skin of the scrotum, there is tenderness in the skin congestion and edema, and the skin boundary of the lesion is clear, often accompanied by systemic symptoms such as fever and chills.
4. Scrotal cellulitis or gangrene: It is an acute infection of the scrotum cellulite. Sudden congestion, swelling, and severe pain. The scrotal skin becomes hard and the color becomes dark. Often accompanied by chills, high fever, nausea, vomiting and other toxic symptoms of wound exudate bacteriological examination, mostly hemolytic streptococcus, Pseudomonas aeruginosa Staphylococcus aureus and anaerobic streptococci mixed infection.
5. Extravasation of urine: There is a history of urinary bladder trauma, or a history of urethral fistula, urine can leak into the scrotum. The scrotum is obviously swollen, the skin is pale, the wrinkles disappear and bright and shiny, and there are obvious depressions. . Urgent treatment is required or infection may be secondary.
6. Scrotal skin cancer: It can thicken and harden the skin of the primary skin cancer or metastatic cancer. The contraction subsides and the surrounding wrinkles can be accompanied by ulcers. Live biopsy can be done to confirm the diagnosis.
Second, the scrotum inclusions lesions:
(a) sheath disease:
1. Hydrocele: The course of general hydrocele can be slow due to inflammatory tuberculosis, tumor, trauma or blood worm infection. The swollen scrotum is cystic, with elastic fluctuation and positive light transmission test. The type of hydrocele can be determined from the shape of the scrotal enlargement and the disappearance of the scrotum. The testicular membrane effusion is smooth, elastic and sac-like; the hydrocele is occluded, and the swollen scrotum can gradually become smaller or even disappear during the examination of the supine position; the position of the spermatic hydrocele is too high. Located above the scrotum. Huge hydrocele can affect walking and labor but no pain. Because the mucus envelops the contents of the scrotum, it is impossible to touch the testicular and epididymis if it is suspected to be a secondary sheath mucus. The testis and epididymis can be carefully examined after the effusion is removed.
2. Hydrocele: Due to trauma or tumor erosion, hemorrhage can occur in the lumen of the sheath, and the light transmission test is negative. The puncture can absorb hemorrhagic fluid.
3. Sisal empyema: From the inflammatory exudation, the road membrane empyema can be expressed as local tenderness, negative light transmission test, often fever.
4. Sphincter sputum: It is due to other signs of filariasis caused by filariasis. The scrotum is cystic enlargement, and there is no negative pressure transmission test. The puncture can suck out the chyle.
(two) epididymal lesions:
1. Epididymitis: The most common scrotal infections are more common in young and middle-aged people. The pathogenic bacteria are retrogradely infected by the urethral vas deferens to the epididymis, and blood infections are classified into specific and non-specific according to the nature of the infection. The former such as tuberculosis gonococcal, chlamydia and other pathogen infection; the latter secondary to prostatitis, seminal vesicure urethral stricture, benign prostatic hyperplasia or long-term indwelling catheter in the urethra, pathogens are mostly urinary tract infections of the disease by disease, can be There are acute epididymitis and chronic grade inflammation. Acute epididymitis is acute, and the halo is suddenly swollen. The tenderness is obviously accompanied by chills, fever, headache, nausea and vomiting. It often involves spermatic cords and thickens the spermatic cord. If the testicle is invaded, it is called epididymal orchitis. Testicular torsion and testicular tumors are differentiated. Chronic epididymitis is mostly chronic epididymitis or chronic infection when it starts. Mostly in the tail of the epididymis, there is a slightly hard texture of the nodule, mild tenderness, and generally no systemic symptoms when tired. Epididymal nodules should be differentiated from epididymal tuberculosis, epididymal tumor sperm cysts, and sperm granuloma.
2. Epididymal tuberculosis: Most secondary to the kidney or prostate seminal vesicle tuberculosis, a chronic course. Early formation of cold abscess or adhesion to the skin of the scrotum, sometimes can form a thin tube when the time is growing. A small number of cases can be similar to acute epididymitis in acute cases. Almost half of the patients have symptoms of urinary frequency, hematuria and other kidney tuberculosis.
3. Semen cyst: It is a cyst caused by semen retention. It may be round and smooth in the epididymis or near it. The elastic, non- tenderness mass can absorb white liquid when puncture, and sperm can be seen under the microscope.
4. Epididymal deposition: In a few cases, there is a slight swelling of the scrotum after ligation. It can be touched on both sides with dizziness and softness, no obvious tenderness. The cause of the disease is unclear may be due to postoperative epididymis blood supply disorders, or affect its absorption function caused by epididymal inflammation or sperm granuloma.
(3) Testicular lesions:
1. Orchitis: multiple secondary to acute arthritis often manifested as epididymal orchitis. The onset is acute, the testicles have painful swelling and obvious tenderness. In severe cases, it can extend to the wall of the scrotum, causing congestion and edema of the scrotal skin with symptoms such as chills and high fever. Mumps is most common in orchitis caused by specific infections. Generally, 70% of cases 4 to 6 days after the onset of mumps are unilateral and more common on the right side.
2. Testicular tumors: Most of them occur at the beginning of young adults between 20 and 40 years old. There are painless small masses on the testicles, which rapidly increase. The enlarged testicles still retain the original shape and hardness, and the epididymis and spermatic cord have no abnormalities. . Light transmission test negative testicular tumors such as secondary hydrocele, the scrotum swelling is obvious. In a small number of cases, the acute testicles rapidly swollen, and there is pain and fever similar to acute rhinitis. The occult rate is prone to tumors, which is manifested as the absence of testicular scrotum in the abdominal mass and the affected side of the scrotum.
(4) spermatic lesions:
1. The spermatic cord is reversed: also called testicular torsion is the testicular twist in the sheath lumen along the spermatic axis. The sheath sheath sheath is closed at high level, and the testicular insufficiency is prone to sudden onset of onset. One side of the spermatic testicular severe pain can be radiated to the umbilicus, and the testicular swelling is accompanied by nausea and vomiting. Testicular upper constriction is a typical sign of this disease. In order to avoid the time and opportunity of misdiagnosis for surgical reduction, in recent years, the use of one or Doppler ultrasound to compare the blood flow perfusion of the testis on both sides, to help timely diagnosis.
2. Varicocele: more common in young adults and more on the left side, bilateral accounted for about 15%. General varicocele has no obvious symptoms or feels a slight swelling of the scrotum, local swelling and so on. Many patients with severe varicocele due to infertility can cause infertility. During the examination, the patient took a standing position. It can be seen that the left scrotum is like a soft worm in the scrotum of the scrotum. If the signs are not obvious, the above signs may disappear when the patient is in a breath holding position. Otherwise, consider whether there is a lumps that compress the veins and affect blood return. In recent years, angiographic diagnostic methods have been helpful in the discovery of patients with varicocele with insignificant signs.
Third, the contents of the abdominal cavity into the scrotum lesions
Inguinal hernia: After birth, the peritoneal sheath is not completely closed or closed, and the abdominal cavity is connected with the scrotum, so that the contents of the abdominal cavity can be inserted into the scrotum to form congenital oblique hernia; if there is an anatomical defect in the inguinal region It is easy to form acquired oblique sputum. Inguinal hernia is the main cause of massive scrotal swelling. The disease is characterized by a swollen scrotum connected to the groin area. The lumps often form a hemispherical shape when standing, walking, coughing or working. Touching the mass with your hand and coughing the patient may have a swelling impact. If the patient rests flat or pushes the mass to the abdominal cavity by hand, the mass can be returned to the abdominal cavity and disappear. If you can't return when you are lying down, it is difficult to relapse, and should be differentiated from other scrotal enlargement. Incarcerated idiots often occur when sudden intra-abdominal pressure increases such as strong labor or defecation. Such as the incarcerated content of the intestinal fistula not only local pain, but also accompanied by abdominal cramps, nausea and vomiting, constipation, abdominal distension and other mechanical intestinal obstruction, if not timely, will eventually form a narrow sputum.
First, the medical history: a detailed inquiry about the history of scrotal enlargement is very important for diagnosis and differential diagnosis. The main course should be to ask about the course of scrotal enlargement, local symptoms and symptoms of the whole body or other systems.
1. The length of the disease course: Infectious scrotal swelling often begins with a sudden onset; the course of hydrocele is slow and often prolonged for several years; testicular tumors generally have a shorter course of disease; elephant swelling has a long history of contact with water, showing progressive development Most of the scrotal cysts caused by inguinal hernia vary with intra-abdominal pressure, and are large and small.
2. Local symptoms: Infectious scrotal cysts are mostly accompanied by redness, heat, pain and other symptoms; testicular or attached tumors often have falling pain; like skin edema often secondary infection due to eczema or ulcers.
3. Systemic or other systemic symptoms: Scrotal swelling with systemic fever, such as epidemic mumps complicated with acute orchitis; epididymal tuberculosis may be accompanied by urinary frequency, urgency, dysuria and other symptoms of urinary tuberculosis.
Second, physical examination:
1. Local palpation: Local palpation is the most important and simple method for diagnosing scrotal enlargement. The scrotum and its contents belong to the external genital organs. The examiner must be familiar with the general anatomy of the contents of the scrotum in order to clearly diagnose the lesion. The scrotum is still the skin of the scrotum; it is the original scrotum content, or from the groin area; is the testicular enlargement, or the epididymis enlargement; is cystic enlargement or substantial enlargement...... During the examination, the patient should take the standing first, and then the person who is in the position examination and check the hands at the same time is helpful for comparison.
2. Cough impact: The inguinal herd and hydrocele were identified by cough impact test on the mass from the abdominal muscle sulcus.
3. Light transmission test: It is of great value for identifying whether the scrotal enlargement is cystic or substantial.
4. Scrotal puncture: In order to identify the nature of the scrotal effusion, puncture and drainage can be performed, but for the substantial enlargement, the tissue can be aspirated for pathological examination.
5. Other examinations: including abdominal examination of the prostate examination and related general examination.
Third, the laboratory examination: hematuria routine and erythrocyte sedimentation test have certain auxiliary diagnostic significance in acute and chronic infection; blood smear microscopic butterfly to find the diagnostic value of the diagnosis of scrotal elephant skin swelling; determination of blood or urine human fluff Membrane gonadotropin (HCG) and alpha-fetoprotein (AFG) are important for the diagnosis of testicular choriocarcinoma or embryonal cancer:
Fourth, imaging diagnosis: mainly by ultrasound Doppler ultrasonography, radionuclide gamma angiography, infrared scrotum temperature recording method (Scrotalthenngraphy) and other comprehensive diagnostic ideas.
