Scrotal swellings 3- Epididymal cyst
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Transcript of Scrotal swellings 3- Epididymal cyst
SCROTAL SWELLINGSCase No:3
PROBLEM ORIENTED CASE BASED LEARNING
Dr.B.Selvaraj MS;Mch;FICSProfessor of Surgery
Melaka Manipal Medical collegeMelaka Malaysia 75150
OVERVIEW
• Various causes(Differential diagnosis) of scrotal swellings• Classical clinical vignette with probable diagnosis• The diagnosis in detail- only one pathology in each
episode• Mind map of the diagnosis• Tabular column of differential diagnosis depicting their
characteristic features to differentiate them from your diagnosis• References and feedback
Causes of Scrotal Swellings ACUTE PAINFUL
• Torsion testis• Acute epididymo-orchitis• Torsion of testicular
appendages
CHRONIC PAINLESS
• Hydrocele• Epididymal cyst• Spermatocele• Chronic epididymo-
orchitis• Testicular tumor• Varicocele
Classical Clinical vignette Epididymal Cyst
• A 45 years old male patient presented with a swelling in right side of the scrotum for last 3 years which is increasing very slowly in size. There is no pain over the swelling.• O/E: There is a soft cystic swelling in relation to the head of
the right epididymis. The swelling has a lobulated surface and feels like a bunch of grapes. • Testis can be felt separately from the swelling• The swelling is brilliantly transilluminant and has Chinese
lantern pattern appearance
Epididymal Cyst- Etiopathogenesis
• These are cysts in connection with the epididymis divided into the following types:• 1. Degeneration cysts occur due to cystic degeneration of the
epididymis Epididymal cyst• 2. Retention cysts due to obstruction of the sperm conducting
mechanism Spermatocele Ex: after vasectomy
Epididymal Cyst- Clinical Features
• Most epididymal cysts occur in males over the age of 40 years• An epididymal cyst usually contains clear fluid• The variety that contains slightly grey, opaque, ‘barleywater’-like
fluid and few spermatozoa is sometimes termed a Spermatocele • They are often multiple or multilocular and are frequently
bilateral and feels like bunch of grapes• Brilliantly transilluminant “Chinese lantern pattern”• Testis palpable separately• Cysts are connected to the head of the epididymis, so lie above
the testis 3rd testis
Epididymal Cyst- Clinical Features
Epididymal Cyst- Clinical Features
Epididymal Cyst Vs Spermatocele
Epididymal Cyst - Treatment
• Single large cyst Excision of cyst• Recurrent or multilocular cyst Excision + partial or
total epididymectomy• No role for aspiration because cysts are multilocular• Spermatocele if big aspiration or excision; If small no
intervention
Epididymal Cyst - Mindmap
Scrotal Swellings- Algorithm
Scrotal Swellings Ex & Px
Hx Sx Dx Tx
1. Hydrocele Primary-IdiopathicSecondary- under lying pathology
Painless big swelling; not reducible
No cough impulseGet above swelling+Transilluminant+
ClinicalIn doubt- USG of scrotum
Lord’s operationJaboulay’s operation
2. Epididymal cyst & Spermatocele
Degenaration of epididymis, occlusion of pathway
Swelling in scrotum resembles 3rd testis
Testis palpable separately; Chinese lantern appearance
ClinicalUSG of scrotum
ConservativeExcision
3. Varicocele IdiopathicAbsence of valves in testicular vein
Worm like in upper scrotum; infertility
Disappears on lying down; Bag of worms appearance
ClinicalUSG color doppler
VaricocelectomyInguinal or Retroperitoneal
4. Testicular torsion & Epididymo- orchitis
Abnormal fixation and lie of testisUTI & trauma
Severe pain& swelling scrotumNausea & vomiting
Tender hemi scrotum; cremasteric reflex absent
ClinicalUSG color doppler
Explore,detorse, orchiopexy or orchidectomyConservative
5. Testicular carcinoma
UDT, Kieinfelter’s Germ cell- Seminoma & Non seminomaNon germ cell tumor
Painless heavy swelling
Not reducibleHard in consistencyTestis felt separately
Clinical; No FNACUSG OF scrotum
High orcidectomy with or without RPLND+ RT+CT
D/D for Scrotal Swellings (Compare & Contrast) (Vertical Reading)
References
• Hunt & Marshall’s clinical problems in surgery 2nd edition• Clinical surgery made easy- a
companion to PBL by Mohan De silva 1st edition• 100 cases in surgery 2nd edition• Case files surgery 4th edition• Clinical scenarios in surgery-
decision making 1st edition• Surgery- a case based clinical
review 1st edition
• Surgery Review by Carlos Pestana• Clinical surgery pearls by
Dr Dayananda Babu 2nd edition• NMS casebook surgery 2nd edition• General Surgery- Correlations &
clinical scenarios 1st edition• Surgery review by Makary 3rd edition• Surgery- Clinical cases uncovered by
Harold Ellis 1st edition• Shelf life surgery 1st edition
Feedback & Suggestions
Thank Youhttps://www.youtube.com/watch?v=hZovqzif3ck