A 55 year-old man presents to the clinic because today he noticed that his left scrotum has suddenly gotten larger. He has no fever or pain. Examination reveals enlarged left scrotum with no tenderness or any signs of inflammation. There is a worm-like mass posterior to the left testicle. The mass illuminates and is not reducible on compression or when the patient lying down.
What is the best next step in management?
A – Assurance and follow up in 2 weeks
B – Abdominal CT scan
C – MRI of the pelvis
D – Urine culture
E – Refer to surgery for urgent reduction
This is a case of combined varicocele and hydrocele. Sudden onset and non-reducible mass suggest obstruction of venous drainage. Left testicular vein drains into left renal vein, so, any compression on the left renal vein causes left varicocele. Most cases of renal cell carcinoma in men are accompanied by left varicocele. For this reason, abdominal CT scan is the best next step to evaluate for any masses or tumors.
The correct answer is B