Examination of SCROTAL SWELLING GENERAL EXAMINATION:
Name: Age: Sex: Occupation: Address: Lungs- To exclude TB ( TB epididymo-orchitis), Malignancy of testis
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HISTORY Syphilitic stigmas (Gummamatous orchitis) {Alopecia, bossing of skull,
1. Age: Hydrocele is seen even in infants, but primary hydrocele is most interstitial keratitis, depression of nasal bridge, nasal septum
common over 40yrs. Secondary hydrocele common in 20-40 years. perforation, Hutchinson teeth, mucous patches, condylomas, otitis
2. Occupation: interna, enlarged occipital lymph nodes, Gummamatous orchitis,
Varicocele develops in men who work which require prolonged Clutton’s joints, Sabre tibia)
standing like bus conductor. Kidneys-TB epididymo-orchitis, varicocele
3. History of present illness: H/O Trauma- haematocele Rectal examination- Acute prostatitis precedes epididymo-orchitis.
LOCAL EXAMINATION-SCROTUM Seminal vesicles are enlarged and tender in tuberculous epididymitis.
A. INSPECTION:
1. Skin and Subcutaneous Tissue:
Normal scrotal skin is wrinkled and freely mobile over testis. Hydrocele
skin will be tense so normal rugosity of skin is lost and subcutaneous
veins are prominent.
2. Swelling: Hydrocele- small to very big, hanging till knee.
A peculiar constriction is often found around swelling. If hydrocele is
tense it tends to stand out (forward projection)
Note size, shape, extent of swelling. Does it extend up laong the
spermatic cord?
3. Impulse on coughing: Many times hydrocele is associated with
hernia- bubonocele or a complete inguinal hernia. Hernia shows
impulse on cough.
B. PALPITATION:
Swelling is purely scrotal is confirmed by getting above the swelling.
1. Skin: Any ulcer-describe it, fixity to testis (Gummamatous) or
epididymis (tuberculous)
2. Swelling: Temperature, tenderness, extent, size, shape, surface,
margins, consistency. Most common cystic swelling is a vaginal
hydrocele (collection of serous fluid in tunica vaginalis)
2 cardinal signs of HYDROCELE:
FLUCTUATION: Thumb and finger of one hand on lower pole push to
see separate thumb and finger of other hand at upper pole.
TRANSLUCENCY: A pencil torch is placed laterally and roll of paper
anteriorly. False Negative if testis comes in the way.
Uncomplicated hydrocele and cyst of epididymis are translucent.
Spermatocele is not translucent as fluid is not clear.
Reducibility of Swelling: Raise swelling and compress it.
Congenital hydrocele and varicocele are reducible. In former always
check ascites as it is associated with TB peritonitis.
Impulse on coughing: Root of scrotum is held, Expansile= hernia or
congenital hydrocele, Thrill like= varicocele or lymph varix.
3. Testis: Position, shape, size, surface (smooth or nodular),
Consistency, weight (compare by balancing testis on palm), Mobility,
testicular sensations.
4. Epididymis: Firm nodular structure attached to posterior aspect of
testis. Globus major (head), body, Globus minor (tail).
5. Spermatic Cord: Palpate at root of the scrotum between thumb and
index finger simultaneously on both sides.
Vas deferens felt as hard whip cord slipping between thumb and index
finger.
Lymph varix- soft and doughy, Varicocele- bag of worms
Both give thrill like impulse on cough but varicocele more readily
reduces.
6. Lymph Nodes: Skin of scrotum- inguinal lymph nodes,
Testis, Epididymis- Pre and Para aortic lymph nodes at level of origin of
testicular artery formation from Aorta. (trans pyloric plane)
Left Supraclavicular lymph node (malignancies)
