Evaluation of scrotal pain or swelling in children and adolescents
- Joel S Brenner, MD, MPH
Joel S Brenner, MD, MPH
- Associate Professor, Sports Medicine and Adolescent Medicine
- Eastern Virginia Medical School
- Aderonke Ojo, MD
Aderonke Ojo, MD
- Associate Professor of Pediatric Emergency Medicine
- Baylor College of Medicine
- Section Editors
- Amy B Middleman, MD, MPH, MS Ed
Amy B Middleman, MD, MPH, MS Ed
- Section Editor — Adolescent Medicine
- Professor of Pediatrics, Chief of Adolescent Medicine
- University of Oklahoma Health Sciences Center
- Gary R Fleisher, MD
Gary R Fleisher, MD
- Editor-in-Chief — Adult and Pediatric Emergency Medicine
- Section Editor — Pediatric Signs and Symptoms
- Egan Family Foundation Professor
- Harvard Medical School
- Laurence S Baskin, MD, FAAP
Laurence S Baskin, MD, FAAP
- Section Editor — Pediatric Urology
- Frank Hinman, Jr., MD, Distinguished Professorship in Pediatric Urology
- Chief Pediatric Urology
- Professor of Urology and Pediatrics
- UCSF Benioff Children's Hospital
- Deputy Editor
- James F Wiley, II, MD, MPH
James F Wiley, II, MD, MPH
- Senior Deputy Editor — UpToDate
- Deputy Editor — Adult and Pediatric Emergency Medicine
- Deputy Editor — Primary Care Sports Medicine (Adolescents and Adults)
- Clinical Professor of Pediatrics and Emergency Medicine/Traumatology
- University of Connecticut School of Medicine
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".)
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 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 :
- Jefferies MT, Cox AC, Gupta A, Proctor A. The management of acute testicular pain in children and adolescents. BMJ 2015; 350:h1563.
- Petrack EM, Hafeez W. Testicular torsion versus epididymitis: a diagnostic challenge. Pediatr Emerg Care 1992; 8:347.
- Lewis AG, Bukowski TP, Jarvis PD, et al. Evaluation of acute scrotum in the emergency department. J Pediatr Surg 1995; 30:277.
- Caesar RE, Kaplan GW. The incidence of the cremasteric reflex in normal boys. J Urol 1994; 152:779.
- Rabinowitz R. The importance of the cremasteric reflex in acute scrotal swelling in children. J Urol 1984; 132:89.