What Are the Common Causes of Scrotal Swelling?

Causes of scrotal swelling

Swelling of the scrotum

Swelling of the scrotum refers to the contents of the scrotum such as the scrotal wall or the sheath testis, epididymis, and spermatic cord. Pathological swelling or inflammatory infiltration of the scrotum can occur due to acute and chronic inflammation, invasion of parasites, and organic changes in the tumor. If the peritoneal sphincter is not closed or not completely closed after birth, the contents of the abdominal cavity can reach the scrotum. Physical examination such as medical history and local palpation light test can be used to determine the location and nature of scrotal enlargement and make a correct diagnosis.

Affected area: Reproductive site
Related diseases: Hemangiomas epididymitis varicocele hydrocele inguinal hernia testis tumor filariasis erysipelas eczema syphilis orchitis male genital trauma scrotum eczema penis scrotal elephantiasis ascites vestibular large cyst scrotal cancer scrotal inflammatory cancer cyst Hernia, hernia, edema, decapsulation, swelling
Related symptoms: Constipation congestion, erysipelasemia, cachexia, nausea, cellulitis, ascites, abdominal distension, high fever, chill, secondary infection, nodular varicocele, local tenderness, severe pain, cough, ulcer, cyst, conjunctiva, urinary urgency, frequent urination, urinary extravasation, abscess, skin adhesion, pale skin, rough skin, prostate hyperplasia Granulomatous nephrotic syndrome eczema edema headache chills heart failure vascular neuroedema blood urinary scrotum swelling

Affiliated Department: Andrology
Related inspections: Scrotal ultrasound

Causes of scrotal swelling

According to the lesions that cause scrotal enlargement, they can be divided into three categories:

(1) Scrotal wall lesions: such as scrotal wall edema, scrotal wall hematoma, scrotal wall elephantiasis after filariasis, erysipelas gangrene, cellulitis, benign tumor of extravasated scrotal wall (sebaceous tumor, hemangioma X scrotal wall Malignant tumor.

(B) lesions of scrotal contents

1. Sheath: hydrothorax, hemorrhage of the sheath, empyema of the sheath, chyle of the sheath.

2. Epididymis: acute and chronic epididymitis, epididymal tuberculosis, stasis and semen cysts after sterilization of epididymal bloodworm.

3. Testis: testicular inflammation testicular tuberculosis, testicular syphilis. Testicular tumor.

4. spermatic cord spermatic cord spermatic cord effusion, spermatic cord varices, spermatic cord twisted spermatic sheath cyst, spermatic cord bloodworm nodule, spermatic cord nodules painful nodules after sterilization, Sperm granulomas.

(3) The contents of the abdominal cavity enter the scrotum, such as ascites or inguinal hernia (small intestine bladder, omentum, etc.) enter the scrotum.

Examination and diagnosis of scrotal swelling

I. Medical history: A detailed inquiry about the history of scrotal enlargement is very important for the diagnosis and differential diagnosis. It should mainly ask about the course of scrotal enlargement, local symptoms and systemic or other system symptoms.

1. Length of the disease course: Infectious scrotal enlargement often has rapid onset of disease; slow progress of the disease of the sheath fluid often delays for several years; testicular tumors generally have a short course of disease; the swollen tumor has a long history of exposure to the epidemic water, showing progressive development Most of the scrotum caused by inguinal defects vary with intra-abdominal pressure.

2. Local Symptoms: Infectious scrotal cysts are mostly accompanied by redness, swelling, pain, and other symptoms; testicular or adjunctive tumors often have pain; elephantioderma often has eczema or ulcers due to secondary infection in the later stages.

3. Systemic or other systemic symptoms: scrotal swelling with acute systemic fever infections such as mumps and acute orchitis; epididymal tuberculosis may be accompanied by symptoms of urinary tuberculosis such as frequent urination, urgency, and dysuria.

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 before it can be clearly diagnosed that the disease occurred. The scrotum is still scrotal skin; is it originated from the scrotal contents or from the groin area; is the testicular enlargement or epididymal enlargement; is it cystic enlargement or substantial enlargement hellip; hellip ;. During the examination, the patient should take a stand first, and then perform a supine examination. The examiner palpates with both hands at the same time, which is good for left-right comparison.

2. Cough impact sensation: For the mass from the inguinal sulcus area, identify the inguinal trace and hydrocele by cough impact inspection.

3. Light transmission test: It is of great value for distinguishing whether scrotal enlargement is cystic or substantial.

4. Scrotal puncture: In order to identify the nature of the scrotal effusion, puncture and fluid examination can be performed, but for substantial swelling, tissue can be aspirated for pathological examination.

5. Other examinations: including prostate examination and abdominal examination and related body examinations.

3. Laboratory examinations: routine hematuria and erythrocyte sedimentation tests have certain auxiliary diagnostic significance in acute and chronic infections; finding microfilaments under a blood smear microscope has diagnostic value for diagnosing scrotal elephantiasis; measuring blood or urine human villi Membrane gonadotropin (HCG) and alpha-fetoglobin (AFG) are of great significance in the diagnosis of testicular chorionic epithelial cancer or embryonic cancer.

IV. Imaging diagnosis: There are ultrasound diagnosis, Doppler ultrasound examination, radionuclide gamma angiography, infrared scrotal temperature recording method (Scrotalthenngraphy) and so on.

Swelling of the scrotum easily confused

Differential diagnosis of scrotal swelling:

First, scrotal wall disease

1. Scrotal edema: due to scrotal allergy (worm bite vascular neuroedema) inflammation, contusion, inferior vena cava return due to tumor compression or systemic diseases (such as heart failure nephrotic syndrome, high ascites, cachexia, etc.) leading to accumulation of scrotal wall tissue Excessive moisture manifests as scrotum swollen, wrinkles disappear, translucent and shiny pressure with obvious depression without tenderness. If accompanied by inflammation, there may be tenderness and congestion.

2. Scrotal elephantiasis: This is a clinical manifestation of urogenital filariasis. The parasitic bloodworm occludes the scrotum and the nearby lymphatic vessels, prevents lymphatic return and overflows, and stimulates the massive proliferation of fibrous tissue in and under the scrotum. Causes swollen pixels. The scrotal skin is rough, the cortex and subcutaneous tissues are extremely thick, and the depression is not easy to occur. The skin of the penis is often involved, so that the penis is invaded. Another is due to the accumulation of lymph fluid, which makes the skin of the scrotum wet. Continuous dripping of lymph fluid can cause secondary infections, and often cause acute lymphangitis such as ulcers and eczema with fever and local swelling and pain. The disease is common in areas where filariasis is endemic. Microfilament butterflies can be found at night by examining the surrounding blood.

3. Erysipelas: Due to inflammatory lesions on the scrotal skin of the lymph network, the congestion and edema of the skin are tender, and the lesions have a clear line of the skin, often accompanied by systemic symptoms such as fever and chills.

4. Scrotal cellulitis or gangrene: It is an acute infection of the scrotal cellulite due to sudden congestion, swelling, and severe pain in the scrotum. The scrotal skin becomes hard and dark in color. The formation of gangrene sometimes has twisting sounds and has a special odor. Often accompanied by chills, fever, nausea, vomiting and other toxic blood symptoms, wound exudate bacteriological examination, mostly for hemolytic streptococcus, Pseudomonas aeruginosa and anaerobic streptococcus mixed infection.

5. Urinary extravasation: history of urethral bladder trauma, or history of urethral sacral canal, urine can leak into the scrotal honeycomb tissue and manifest as obvious scrotal swelling, pale skin, wrinkles disappear, translucent and shiny, and obvious depression according to it . Urgent treatment is required, otherwise secondary infections may occur.

6. Scrotal skin cancer: It can be local skin thickening or hardening of primary skin cancer or metastatic cancer lesions, shrinkage and depression, and radial wrinkles around it can be accompanied by ulcers. Biopsy can be done to confirm the diagnosis.

Lesions of scrotal contents

(A) sheath disease

1. Hydrocele: It can be caused by inflammatory tuberculosis, tumors, trauma, or infection with bloodworms, and the general course of hydrocele is slow. The enlarged scrotum is cystic, has a sense of elastic fluctuation, and the light transmission test is positive. From the shape and location of scrotal enlargement and disappearance when lying down, the type of hydrocele can be determined. The testicular effusion is smooth in pear shape, elastic and cystic; the trafficous effusion, the swollen scrotum can gradually become smaller and even disappear when the lying position is examined; the position of the seminiferous effusion is high, Located above the scrotum. Huge effusions can affect walking and labor without pain. Because the mucus covers the contents of the scrotum, you cannot touch the testes and epididymis. If you suspect a secondary sheath mucus, you can check the testis and epididymis carefully after aspiration.

2. Hematuria: due to trauma or tumor erosion, blood can appear in the sheath cavity, negative light transmission test, puncture can suck bleeding fluid.

3. Pelvic empyema: Exudative effusion can make the empyema of the pericardium manifest as local tenderness, negative light transmission test, and often fever.

4. Hydatid chyle: It is caused by filariasis and may be accompanied by other signs of blood filariasis. The scrotum was cystic, and the tenderness test without tenderness was negative. The puncture could aspirate the chyle.

(B) epididymal lesions

1. Epididymitis: The most common infectious disease in the scrotum is more common in young people. Pathogens are retrogradely infected from the ureteral vas deferens to the epididymis, and there are also bloodstream infections that can be divided into specific and non-specific depending on the nature of the infection. The former are infected with pathogens such as tuberculosis gonococcus and chlamydia; the latter are mostly secondary to prostatitis, seminal vesiculitis, urethral stricture, prostatic hyperplasia, or long-term indwelling of the catheter in the urethra. There are acute epididymitis and chronic appendicitis. Acute epididymitis has an acute onset, sudden swelling of the epididymis, tenderness with chills, fever, headache, nausea and vomiting, often involving the spermatic cord, making the spermatic cord thicker; if it invades the testis, it is called epididymis orchitis Differentiation of testicular torsion from testicular tumors. Chronic epididymitis is mostly a chronic infection after the onset of acute epididymitis. Mostly in the epididymal tail, there are nodules with a slightly hard texture, mild tenderness, and aggravation when tired, generally without systemic symptoms. The epididymal nodules should be distinguished from epididymal tuberculosis, sperm cysts of the epididymal tumor, and sperm granuloma.

2. Epididymal tuberculosis: most secondary to renal or prostate seminal vesicle tuberculosis, showing a chronic course. Early formation of cold abscesses or adhesions to the scrotal skin, sometimes thinner tubes can be formed when the hair becomes heavier. In a few cases, the acute course is similar to that of acute epididymitis. Almost half of the patients have symptoms of renal tuberculosis such as frequent urination and hematuria.

3. Semen cysts: Cysts caused by semen retention may be round and smooth on or near the epididymis, and elastic, non-tender masses can suck milky liquids when punctured, and sperm can be seen under the microscope.

4. Epididymal stasis: Few cases have mild scrotal swelling after ligation. Both sides can be touched with dizziness and softness, without obvious tenderness. The cause of the disease is unclear. It may be caused by epididymal blood supply failure after surgery, or affect its absorption function and cause epididymal inflammation or sperm granuloma.

(Three) testicular lesions

1. Orchitis: Many secondary to acute appendicitis often manifest clinically as epididymitis. Sudden onset, painful swelling and marked tenderness in the testes. Severe cases can extend to the scrotal wall, causing scrotal skin congestion and edema adhesions accompanied by systemic chills and high fever and other symptoms. Mumps is most common among orchitis caused by specific infections. Generally, 70% of cases occurred 4-6 days after mumps were unilateral and more common on the right.

2. Testicular tumor: It usually occurs when there is a painless small lump on the testis at the beginning of young adults aged 20 to 40 years old, and it grows rapidly. The enlarged testicle still retains its original shape and stiffness, and the epididymis and spermatic cord are normal. . If the testicular tumor with negative light transmission test is secondary to hydrocele, the scrotum is enlarged. In a few cases, the acute testicles swelled rapidly, with pain and fever similar to acute rhinitis. Hidden rates are prone to tumors, manifested by the absence of abdominal masses and testes in the scrotum of the affected side. To determine the nature of the tumor, a pathological examination is required.

(D) spermatic cord disease

1. spermatic cord torsion: also known as testicular torsion is the testicular twist in the sheath cavity along the spermatic cord axis. The sheath sheath process is closed at a high level, and those with insufficiency of the testicles are prone to reverse the sudden onset. Severe pain in one side of the spermatic cord can radiate to the umbilicus, and the testicles swell quickly with nausea and vomiting. Testicular overhang is a typical sign of this disease. In order to avoid misdiagnosis and strive for the time and opportunity for surgical reduction, in recent years, one-sided or Doppler ultrasonography has been used to compare the testicular blood flow perfusion on both sides, which is helpful for timely diagnosis.

2. Varicocele: It is more common in young adults and multiple on the left side and about 15% on both sides. Generally, those with varicocele have no obvious symptoms or feel a slight swelling of the scrotum and local swelling. Many patients with severe varicocele due to infertility can cause infertility. The patient took a standing position during the examination, and it was seen that the veins in the scrotum of the left scrotum were looser and drooping than the right. If the signs are not obvious, the patient can be instructed to hold the supine position and the above signs disappear. Otherwise, you can consider whether there is a mass that compresses the vein and affects blood flow. In recent years, diagnostic methods of vascular imaging have helped to identify patients with varicocele with insignificant signs.

Third, the lesions of the abdominal cavity into the scrotum

Inguinal hernia: The peritoneal sheath process is not completely closed or incompletely closed after birth, so that the abdominal cavity and the scrotum communicate with each other. It is easy to form acquired oblique hernia. Inguinal hernia is the main cause of giant scrotal enlargement. The disease is characterized by a swollen scrotum connected to the groin area, which often appears as a pear-shaped hemisphere when standing, walking, coughing, or working. Touch the lump with your hand and ask the patient to cough. There may be an expansive shock. For example, if the patient is lying on his back or pushes the lump to the abdominal cavity with his hand, the lump can be absorbed into the abdominal cavity and disappear. If the recumbency can not be accepted when lying in bed, it is irreversible and should be distinguished from other scrotal enlargements. Incarcerated insults often occur when sudden intra-abdominal pressure increases, such as forced labor or bowel movements, appear as a sudden increase in hernia mass and significant pain. If the content of incarceration is not only severe local pain, but also accompanied by abdominal cramps, nausea, vomiting, constipation, abdominal distension and other symptoms of mechanical intestinal obstruction, if not treated in time, a narrow hernia will eventually form.

Physical examination

2. Cough impact sensation: For the mass from the inguinal sulcus area, identify the inguinal trace and hydrocele by cough impact inspection.

3. Light transmission test: It is of great value for distinguishing whether scrotal enlargement is cystic or substantial.

5. Other examinations: including prostate examination and abdominal examination and related body examinations.

IV. Imaging diagnosis: There are ultrasound diagnosis, Doppler ultrasound examination, radionuclide gamma angiography, infrared scrotal temperature recording method (Scrotalthenngraphy) and so on.

Prevention of scrotal swelling

1. Men must learn to check the scrotum by themselves: the most important tissues in the scrotum are the testis, epididymis, and spermatic cord. Check the following issues:

1) Check if the testicles are swollen, if there is pain during light pressure, and if there are any irregular lumps on the surface of the testes.

2) While touching the testicles, you may treat the epididymis as a foreign body. The epididymis is a flat strip attached to the back of the testicles, about 5-6 cm long. The upper end of the epididymis is swollen and obtusely called the epididymis head. During the examination, you can squeeze gently with your index finger and thumb, and pay attention to whether there are painful induration caused by inflammation, soft and fluctuating semen cysts, or epididymosis and stasis due to blocked vas deferens.

3) Touch the testicle upwards and you will feel the spermatic cord, which is a bunch of cord-like tissues located in the upper part of the testicle. Gently twist with your thumb and forefinger, you can feel that there is a small tube like a twine, this is the vas deferens. When checking the spermatic cord, it is worth noting that the whole tube is smooth, and there is no mass like earthworms in the middle. If you press it gently, it will feel smaller. If you do nt feel smooth, but there are no obvious clumps, try It may be clear by holding your breath, this is the dilated spermatic cord vein. Varicocele is one of the main causes of male infertility.

4) When you find a lump when you check the scrotum, or if there are other things in the scrotum, or if there is a large difference between the sides, you should immediately seek a doctor for further examination. Do not make it uncomfortable because you do not feel uncomfortable. Prolonged disease.

2. Scrotal skin injuries are more common, such as scratches, abrasions, or stings caused by zippers. Prevention points: Take protective measures to avoid injuries. If the scrotum skin is bruised or hematoma after injury. Even the scrotum was torn and the testicles were exposed on the surface. If it is handled properly, the scrotal skin wound can heal quickly, so there is no need for special emergency treatment. Consult a specialist for larger wounds. If the skin has not been torn, you can rest in bed and apply a cold compress locally to relieve pain; if the scrotum is torn and the testicles are exposed on the surface, tetanus antitoxin injections should be injected to locally debride and remove foreign bodies, and the testes should be treated with antibiotics. Prevent re-infection; if the scrotal skin is completely torn off, surgery is needed to rebuild the scrotum.

3. Due to its special location, the scrotum is not airy and relatively humid. In addition, the skin is mainly thin stratum corneum, and the blood vessels and nerves are relatively abundant. It is often rubbed by underwear and is prone to many skin diseases: such as jock itch, scabies , Pruritus scrotum, scrotal neurodermatitis, scrotal eczema, fixed drug rash, etc. Prevention points: Pay attention to personal hygiene habits, do not over-tighten underwear, underwear should be soft, breathable cotton cloth. Regular life, do not eat irritating food. Scrotal skin diseases are common, and most of them are not difficult to treat as long as the diagnosis is accurate. For example, as long as the fixed drug rash is no longer taking allergenic drugs, jock itch only takes a few days for anti-fungal ointment hellip; hellip; it will soon relieve the pain. Therefore, men suffering from scrotal skin disease, do not miss the necessary treatment because they feel that itching is not the place and it is difficult to open their teeth.

What Are the Common Causes of Scrotal Swelling?

Swelling of the scrotum

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