Scrotal Mass
Pathway Home
Population Covered By The Guidance
This pathway provides guidance on the imaging of adult male patients with a scrotal mass.
Date reviewed: July 2018
Date of next review: October 2023
Published: April 2019
Quick User Guide
Move the mouse cursor over the PINK text boxes inside the flow chart to bring up a pop up box with salient points.
Clicking on the PINK text box will bring up the full text.
The relative radiation level (RRL) of each imaging investigation is displayed in the pop up box.
SYMBOL | RRL | EFFECTIVE DOSE RANGE |
![]() |
None | 0 |
![]() |
Minimal | < 1 millisieverts |
![]() |
Low | 1-5 mSv |
![]() |
Medium | 5-10 mSv |
![]() |
High | >10 mSv |
Images
Teaching Points
Teaching Points
- Ultrasound is the preferred imaging modality to evaluate a scrotal mass 1-3
- Ultrasound can be used to differentiate between intra and extra testicular masses. It is also useful for differentiating solid from cystic masses 4
- A painless solid testicular mass is pathognomonic for testicular tumour, 1 though a proportion present with pain
- A mass in the body of the testicle is likely malignant until proven otherwise and is an indication for urgent urology referral
References
References
References are graded from Level I to V according to the Oxford Centre for Evidence-Based Medicine, Levels of Evidence. Download the document
- National Comprehensive Cancer Network. NCCN Clinical practice guidelines in oncology (NCCN guidelines). Testicular cancer. 2016. (Guideline). View the reference
- Albers P, Albrecht W, Algaba F, Bokemeyer C, Cohn-Cedermark G, Fizazi K, et al. EAU Guidelines. Edn. presented at the EAU Annual Congress Copenhagen. European Association of Urology; 2018. (Guideline). View the reference
- Yacoub JH, Oto A, Allen BC, Coakley FV, Friedman B, Hartman MS, et al. ACR appropriateness criteria staging of testicular malignancy. J Am Coll Radiol. 2016;13(10):1203-9. (Guideline). View the reference
- Coursey Moreno C, Small WC, Camacho JC, Master V, Kokabi N, Lewis M, et al. Testicular tumors: what radiologists need to know--differential diagnosis, staging, and management. Radiographics. 2015;35(2):400-15. (Review article). View the reference
- Baird DC, Meyers GJ, Hu JS. Testicular cancer: diagnosis and treatment. Am Fam Physician. 2018;97(4):261-8. (Review article). View the reference
- Zucca E, Roggero E, Bertoni F, Cavalli F. Primary extranodal non-Hodgkin's lymphomas. Part 1: Gastrointestinal, cutaneous and genitourinary lymphomas. Ann Oncol. 1997;8(8):727-37. (Review article). View the reference
- Adeyoju AB, Collins GN, Pollard AJ, Liaw J, Brooman PJ, O'Reilly PH. A prospective evaluation of scrotal ultrasonography in clinical practice. BJU Int. 2000;86(1):87-8. (Level II evidence). View the reference
- Rifkin MD, Kurtz AB, Pasto ME, Goldberg BB. Diagnostic capabilities of high-resolution scrotal ultrasonography: prospective evaluation. J Ultrasound Med. 1985;4(1):13-9. (Level II evidence). View the reference
- Kim W, Rosen MA, Langer JE, Banner MP, Siegelman ES, Ramchandani P. US MR imaging correlation in pathologic conditions of the scrotum. Radiographics. 2007;27(5):1239-53. (Review article). View the reference
- Tallen G, Hernaiz Driever P, Degenhardt P, Henze G, Riebel T. High reliability of scrotal ultrasonography in the management of childhood primary testicular neoplasms. Klin Padiatr. 2011;223(3):131-7. (Level III evidence). View the reference
- Guthrie JA, Fowler RC. Ultrasound diagnosis of testicular tumours presenting as epididymal disease. Clin Radiol. 1992;46(6):397-400. (Level II evidence). View the reference
- Yagil Y, Naroditsky I, Milhem J, Leiba R, Leiderman M, Badaan S, et al. Role of Doppler ultrasonography in the triage of acute scrotum in the emergency department. J Ultrasound Med. 2010;29(1):11-21. (Level II evidence). View the reference
- Shaida N, Berman LH. Percutaneous testicular biopsy for indeterminate testicular lesions. The British Journal of Radiology. 2012;85(Spec Iss 1):S54-S8. (Review article). View the reference
- Epstein BE, Order SE, Zinreich ES. Staging, treatment, and results in testicular seminoma. A 12-year report. Cancer. 1990;65(3):405-11. (Level III evidence). View the reference
- Leibovitch L, Foster RS, Kopecky KK, Donohue JP. Improved accuracy of computerized tomography based clinical staging in low stage nonseminomatous germ cell cancer using size criteria of retroperitoneal lymph nodes. J Urol. 1995;154(5):1759-63. (Level II evidence). View the reference
- Husband JE, Barrett A, Peckham MJ. Evaluation of computed tomography in the management of testicular teratoma. Br J Urol. 1981;53(2):179-83. (Level III evidence). View the reference
- Richie JP, Garnick MB, Finberg H. Computerized tomography: how accurate for abdominal staging of testis tumors? J Urol. 1982;127(4):715-7. (Level II evidence). View the reference
- Hilton S, Herr HW, Teitcher JB, Begg CB, Castellino RA. CT detection of retroperitoneal lymph node metastases in patients with clinical stage I testicular nonseminomatous germ cell cancer: assessment of size and distribution criteria. AJR Am J Roentgenol. 1997;169(2):521-5. (Level II evidence). View the reference
- Strohmeyer T, Geiser M, Ackermann R, Mumperow E, Hartmann M. Value of computed tomography in the staging of testicular tumors. Urol Int. 1988;43(4):198-200. (Level II-III evidence). View the reference
- Thomas JL, Bernardino ME, Bracken RB. Staging of testicular carcinoma: comparison of CT and lymphangiography. AJR Am J Roentgenol. 1981;137(5):991-6. (Level II-III evidence). View the reference
- Sohaib SA, Koh DM, Barbachano Y, Parikh J, Husband JE, Dearnaley DP, et al. Prospective assessment of MRI for imaging retroperitoneal metastases from testicular germ cell tumours. Clin Radiol. 2009;64(4):362-7. (Level II-III evidence). View the reference
- Kok HK, Leong S, Torreggiani WC. Is magnetic resonance imaging comparable with computed tomography in the diagnosis of retroperitoneal metastasis in patients with testicular cancer? Can Assoc Radiol J. 2014;65(3):196-8. (Review article). View the reference
- DeWitt ME, Greene DJ, Gill B, Nyame Y, Haywood S, Sabanegh E, Jr. Isolated right varicocele and incidence of associated cancer. Urology. 2018 (Level II evidence). View the reference
- Skinner DG, Colvin RB, Vermillion CD, Pfister RC, Leadbetter WF. Diagnosis and management of renal cell carcinoma. A clinical and pathologic study of 309 cases. Cancer. 1971;28(5):1165-77. (Level II evidence). View the reference
- El-Saeity NS, Sidhu PS. "Scrotal varicocele, exclude a renal tumour". Is this evidence based? Clin Radiol. 2006;61(7):593-9. (Review article). View the reference
- Tyloch JF, Wieczorek AP. Standards for scrotal ultrasonography. Journal of Ultrasonography. 2016;16(67):391-403. (Review article). View the reference
Information for Consumers
Information for Consumers
Information from this website |
Information from the Royal Australian and New Zealand College of Radiologists’ website |
Consent to Procedure or Treatment Radiation Risks of X-rays and Scans |
Iodine-Containing Contrast Medium Radiation Risk of Medical Imaging for Adults and Children |
File Formats
Some documents for download on this website are in a Portable Document Format (PDF). To read these files you might need to download Adobe Acrobat Reader.