Differentials
Paratesticular mass
SIGNS / SYMPTOMS
Usually the testis is normal, and the mass is firm and quite large by the time the patient presents.
INVESTIGATIONS
Ultrasound will show a solid mass along the spermatic cord.
Cord hydrocele
SIGNS / SYMPTOMS
Fluid, not veins, palpable along the spermatic cord, separate from the testis. Transilluminates using penlight (varicoceles do not transilluminate).
INVESTIGATIONS
Ultrasound will show fluid collection alongside spermatic cord.
Inguinal hernia
SIGNS / SYMPTOMS
Typically lies superomedial to the pubic tubercle.
The patient may report a dragging sensation in the groin or an intermittent bulge that disappears when lying flat.
INVESTIGATIONS
Ultrasound will show abnormal ballooning of the anteroposterior diameter of the inguinal canal.
Spermatocele
SIGNS / SYMPTOMS
Cyst attached to the head of the epididymis. Smooth and able to get above it on examination. Often transilluminates.
INVESTIGATIONS
Ultrasound will show cystic structure on head of epididymis clearly separate from testis.
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