CASE # 3

1. CASE # 3 Amaro.Amolenda.Anacta

2. 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.

4. 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.

5. 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

6. 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

7. 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*

8. 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

9. Initial AssessmentLate-Onset Hydrocele

10. DIAGNOSIs

11. 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 willshow the outline of the testicle,indicating a clear fluid surrounding it

12. Ultrasound • often used to confirm the diagnosis of hydrocele as it providesexcellent 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

13. Ultrasound of Hydrocele

14. 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.