amaro.amolenda.anacta. a 35-year old male comes to your clinic with the following problem of 10...
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CASE # 3Amaro.Amolenda.Anacta
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Case #3
A 35-year old male comes to your clinic with the following problem of 10 years duration. Except for the mass, he is relatively asymptomatic.
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Differential Diagnosis
HYDROCELE Collection of serous fluid that results from a defect or irritation in
the tunica vaginalis of the scrotum Adult hydroceles are usually late-onset (secondary). Late-onset
hydroceles may present acutely from local injury, infections, and radiotherapy; they may present chronically from gradual fluid accumulation. Morbidity may result from chronic infection after surgical repair. Hydrocele can adversely affect fertility.
Clinical Manifestation:• Most hydroceles are asymptomatic or subclinical*• The patient may report a sensation of heaviness, fullness, or
dragging.
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Differential Diagnosis
TESTICULAR TORSION Testicular torsion occurs when a testicle rotates on the
spermatic cord, which provides blood flow to the testicle* Testicular torsion is most common in males under 25, but
it can occur at any age, including in newborns and infants.
Clinical Manifestation:• Sudden or severe pain in one testicle • Swelling of the scrotum (a loose bag of skin under your penis that
contains your testicles) • Nausea and vomiting • Abdominal pain • Fever
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Differential Diagnosis
ORCHITIS Orchitis is an acute inflammatory reaction of the testis
secondary to infection. Most cases are associated with a viral mumps infection; however, other viruses and bacteria can cause orchitis.
Clinical Manifestation:• Testicular swelling on one or both sides • Pain ranging from mild to severe • Tenderness in one or both testicles • Nausea • Fever • Discharge from penis • Blood in semen
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Differential Diagnosis
INGUINAL HERNIA Inguinal hernias occur when soft tissue,
usually part of the intestine protrudes through a weak point or tear in the lower abdominal wall. *
Some inguinal hernias have no apparent cause. But many occur as a result of: (1) Increased pressure within the abdomen, (2) A pre-existing weak spot in the abdominal wall, (3) A combination of the two*
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Differential Diagnosis
Clinical Manifestation A bulge in the area on either side of your
pubic bone Pain or discomfort in your groin, especially
when bending over, coughing or lifting A heavy or dragging sensation in your groin Occasionally, in men, pain and swelling in the
scrotum around the testicles when the protruding intestine descends into the scrotum
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Initial AssessmentLate-Onset Hydrocele
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DIAGNOSIS
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Physical Examination
Enlarged, non tender scrotum Testicles cannot be palpated If there’s an associated inguinal hernia,
pressure on the abdomen or scrotum will enlarge or shrink the fluid-filled sac
Transillumination shine a flashlight at the swollen area of the
scrotum the light will show the outline of the testicle,
indicating a clear fluid surrounding it
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Ultrasound
often used to confirm the diagnosis of hydrocele as it provides excellent detail of the testicular parenchyma
rule out a tumor, torsion, spermatocele or other conditions
if a testicular tumor is a diagnostic consideration, ultrasonography is an excellent screening study
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Ultrasound of Hydrocele
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Plain abdominal radiography
Plain radiography may be useful for distinguishing an acute hydrocele from an incarcerated hernia
Gas overlying the groin may indicate an incarcerated hernia.