Pediatric Scrotal Masses

Boys frequently present to the emergency department with the chief complaint of acute or chronic scrotal swelling. The emergency physician is often able to make a diagnosis based on history and physical examination alone; however, adjunctive imaging can be helpful in determining the etiology in equivocal cases. This article reviews the anatomical considerations in the pediatric patient, which predispose to the development of scrotal masses. In addition, it reviews the diagnosis and treatment of common scrotal masses, including inguinal hernias and hydroceles, and provides tips to distinguish between simple, communicating, and cord hydroceles. More unusual pediatric diagnoses, such as varicoceles and scrotal and testicular tumors, are also discussed, along with indications for urgent or emergent referral to a pediatric surgeon or urologist.