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Evaluation of scrotal pain or swelling in children and adolescents

Authors
Joel S Brenner, MD, MPH
Aderonke Ojo, MD
Section Editors
Amy B Middleman, MD, MPH, MS Ed
Gary R Fleisher, MD
Laurence S Baskin, MD, FAAP
Deputy Editor
James F Wiley, II, MD, MPH

INTRODUCTION

The spectrum of conditions that affect the scrotum and its contents ranges from incidental findings to pathologic events that require expeditious diagnosis and treatment (eg, testicular torsion, testicular cancer). The evaluation of scrotal pain or swelling in children and adolescents will be discussed here.

The causes of scrotal pain and swelling are discussed separately, as is the evaluation of the acute scrotum in adults. (See "Causes of scrotal pain in children and adolescents" and "Causes of painless scrotal swelling in children and adolescents" and "Evaluation of acute scrotal pain in adults".)

CLINICAL ANATOMY

The tunica vaginalis and the epididymis are two important landmarks for the testicular examination (figure 1). The tunica vaginalis is a structure containing a potential space that encompasses the anterior two-thirds of the testicle in which fluid from a variety of sources may accumulate. The epididymis usually is positioned posterolaterally to the testicle and must be differentiated from an abnormal mass. The spermatic cord, which consists of the testicular vessels and the vas deferens, is connected to the base of the epididymis.

EVALUATION

Evaluation of scrotal pain or swelling begins with a careful history and physical examination. Based upon these findings further ancillary studies, such as Doppler ultrasonography, and urine testing establish the diagnosis.

History — A focused history in a boy with scrotal pain or swelling can help to narrow the differential diagnosis and lead to a more productive examination. The essential points include [1]:

            
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Literature review current through: Sep 2017. | This topic last updated: Aug 07, 2017.
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