The document presents a series of clinical vignettes focusing on various types of scrotal swellings in male patients, detailing patient histories, observations, and differential diagnoses. Each case includes specific questions regarding diagnostics, management, and complications, emphasizing the importance of understanding the underlying conditions. The teaching aims to enhance clinical reasoning and surgical decision-making regarding scrotal swelling presentations.

1. SCROTAL
SWELLINGS
CLINICAL VIGNETTES-CASE
TRIGGERS
Dr. B. Selvaraj MS; Mch; FICS;
Professor of Surgery
Melaka Manipal Medical College
Melaka 75150 Malaysia

2. LEARNING OUTCOMES
ANY CLINICAL TEACHING

3. SCROTAL SWELLINGS
DIFFERENTIAL DIAGNOSIS

4. SCROTAL SWELLINGS
DIAGNOSTIC ALGORITHM

5. CASE NO: 1:
35-year-old male patient presented with painless progressively increasing right sided scrotal
swelling for the past 2 years. O/E: 10x15 cms sized scrotal swelling palpable in right scrotum
which was not tender, fluctuant, transilluminant, not reducible with no cough impulse. Get
above the swelling was +ve
A. What is your diagnosis and
why you are saying so?
B. What are the other questions
you will ask in history?
C. What clinical tests are being
performed in Fig2,3,4 &5 ?
D. What are the seven types of
Hydrocele?
E. What Surgeries are being
done in Fig7 and Fig8 ?
F. What are the post-op
complications?
‘I’ve developed a painless swelling in my scrotum’

6. CASE NO: 2: ‘I have developed a swelling just above my left testis as if a
third testis’
45 years old male patient presented with a painless, progressively
increasing swelling in left side of the scrotum for the past 3 years.
O/E: soft cystic swelling palpable just above the left testis which is
fluctuant and transilluminant. Testis palpable separately
.
A. What is your diagnosis and why you are
saying so?
B. What are the two types of cysts in this
pathology and how they develop?
C. What you are seeing in Fig 2 and Fig 3?
D. How would you manage this case?

7. CASE NO: 3: ‘I have developed a painful left scrotal swelling all of a
sudden’
14-year-old boy presented with right scrotal and RLQ pain for the
past 4 hours. He had vomiting twice. He denied any similar previous
episodes or H/O trauma. O/E: skin overlying the right scrotum was
erythematous and edematous. Right testicle is exquisitely tender and
cremastric reflex absent on right side.
A. What is your diagnosis and why you are
saying so?
B. What are the causes for acute painful
scrotal swellings?
C. What are you seeing in Fig1 and Fig2?
D. What you are seeing in Fig 3 and Fig 4?
E. What are the complications?
F. How will you manage this patient?

8. CASE NO: 4: ‘I have developed dilated bunch of veins in Lt Scrotum ’
A 50 –years-old male patient presented with a swelling in the left side of
the scrotum for last 4years which started in the lower part of scrotum
and had gone up to the root of scrotum. Swelling disappears on lying
down and reappears on standing. O/E: A mass of dilated veins feeling
like bag of worms in Lt scrotum was palpable.
A. What is your diagnosis and why you
are saying so?
B. What is the etiology of this lesion?
C. Why is it common on the left side?
D. What are gradings?
E. What is the gold standard
investigation?
F. Why they develop infertility?
G. How will you manage this patient?

9. CASE NO: 5: ‘I have developed a heavy solid lump in the scrotum’
A 22 –years-old male patient presented with a painless swelling in his
right scrotum for the past 3 weeks. The swelling was not increasing in
size. No H/O trauma, fever or burning micturition O/E: 5x4cms size hard
painless mass in his Rt testis. Paraaortic and Virchow’s nodes palpable
A. What is your diagnosis and why you are
saying so?
B. What are the risk factors of this lesion?
C. What are the symptoms & signs?
D. What is the classification of this lesion?
E.What are the gradings?
F.What is the gold standard investigation?
G.How will you manage this patient?

10. THANK
YOU