Scrotal Pain

Eva Ilse Rubio, MD

DIFFERENTIAL DIAGNOSIS

Common

Less Common

ESSENTIAL INFORMATION

Key Differential Diagnosis Issues

Helpful Clues for Common Diagnoses

Epididymoorchitis
- Epididymis/testis often enlarged, hypoechoic/heterogeneous, hypervascular
- Reactive hydrocele often present
- If recurrent, consider congenital anomaly
Testicular Torsion
- Appearance depends on duration
  - Acute: Enlarged, hypoechoic, absent flow
  - Subacute/chronic: Heterogeneous, hydrocele, or peritesticular hyperemia
Inguinal Hernia
- Loops of bowel in scrotum usually peristalse, though not always
- Hernia contents can be mesentery only
Torsion of Testicular/Epididymal Appendage
- May involve appendix testis, appendix epididymis, paradidymis
- US appearance
  - Small, echogenic or hypoechoic knot
  - Hyperemia/hydrocele may mimic epididymitis
Varicocele
- Tubular anechoic structures with blood flow on color Doppler with Valsalva
- Usually left sided, occasionally bilateral
  - If unilateral on right, search for underlying venous obstruction
Hydrocele, Primary or Secondary
- May be simple fluid or complex with septations, debris

Helpful Clues for Less Common Diagnoses

Primary Neoplasms: Germ Cell Tumors, Stromal Cell Tumors
- US characteristics nonspecific
  - Focal or diffuse abnormality
  - Hydrocele or hyperemia may be present
  - Hematoma after minor trauma: Follow to resolution to exclude underlying lesion
Metastases: Leukemia, Lymphoma, Neuroblastoma
- US characteristics nonspecific
  - Focal or diffuse abnormality
  - May be unilateral or bilateral