1. D.D. of Scrotal & Inguino-scrotal Swellings
ALI SABBOUR
Prof. of General & Vascular Surgery, Ain Shams University

2. 1- Can you get above the swelling?
FIRST, Decide the answer of these four questions:
1- Can you get above the swelling?
2- Can you identify the testes & the epididymis?
3- Is the swelling translucent?
4- Is the swelling tender?

3. Swellings NOT Confined to the Scrotum:
Cough Impulse
Reducible
Testis palpable
Opaque
No cough impulse
Not reducible
Testis not palpable
CYSTIC
TRANSLUCENT
HERNIA
INFANTILE HYDROCELE

4. Swellings NOT Confined to the Scrotum:
Cough Impulse
Reducible
Testis palpable
Opaque

5. Swellings NOT Confined to the Scrotum:
No cough impulse
Not reducible
Testis not palpable
CYSTIC
TRANSLUCENT

6. Swellings Confined to the Scrotum: Testis & Epididymis NOT Definable
Translucent
Opaque
Not Tender
Tender
Ch. Hematocele
Torsion
Acute Hematocele
Severe epid.orchitis
Vaginal Hydrocele
Gamma / Tumour

7. Swellings Confined to the Scrotum: Testis & Epididymis NOT Definable
Translucent

8. Swellings Confined to the Scrotum: Testis & Epididymis NOT Definable
Opaque
Not Tender

9. Swellings Confined to the Scrotum: Testis & Epididymis NOT Definable
Opaque
Tender

10. Swellings Confined to the Scrotum:
Testis & Epididymis DEFINABLE
Translucent
Opaque
TENDER
NOT TENDER
Epididymal Cyst
Acute Epididymo-orchitis TB
Epididymis
Tumour (early)
Hydrocele of Cord
Cystic & Opaque (Spermatocele)

11. Swellings Confined to the Scrotum: Testis & Epididymis DEFINABLE
Translucent
Cystic

12. Swellings Confined to the Scrotum: Testis & Epididymis DEFINABLE
Opaque
TENDER

13. Swellings Confined to the Scrotum: Testis & Epididymis DEFINABLE
Opaque
NOT TENDER

14. VARICOCELE Inguino- scrotal Swelling
Bunch of dilated tortuous veins in the pampiniform plexus (Varicose veins in the spermatic cord)
More on the left side
Veins empty when the patient is lying down
VARICOCELE

16. Scrotal Swelling
Can’t feel testis & epididymis
Cystic, translucent
Not tender
Vaginal Hydrocele

17. Acute Lt. inguinal lymphadenitis Lt. strangulated inguinal hernia
Strangulated Lt. inguinal hernia
Rt. congenital inguinal hernia