Blood, blood-forming organs – immune system (D50-D90).
- Purpura Schoenlein-Henoch (Purpura anaphylactoides) – spontaneous small skin hemorrhages, especially in the lower leg area (pathognomonic), occurring mainly after infections or due to drugs or food; the epididymis or testis is often enlarged.
Mouth, esophagus (esophagus), stomach and intestines (K00-K67; K90-K93).
- Appendicitis (inflammation of the appendix) with peritonitis (inflammation of the peritoneum) when the processus vaginalis peritonei (funnel-shaped protrusion of the peritoneum into the scrotum) is persistent
- Incarcerated inguino-scrotal hernia, the (incarcerated inguinal testicular hernia), which can lead to a possible underperfusion (underperfusion) of the testicle as a result; very acute course.
Neoplasms – tumor diseases (C00-D48).
- Testicular tumor, unspecified (95% of all testicular space-occupying tumors are germ cell tumors; these are usually painless; however, hemorrhage can cause acute scrotum) – see below Testicular tumor.
- Leukemia (blood cancer)
- Lymphoma – malignant neoplasm originating from the lymphatic system.
- Testicular space-occupying lesions (2.7% in adults; five patients underwent radical orchiectomy (testicular removal) for tumor)
- Cysts of the epididymis (3.4% in adults).
Genitourinary system (kidneys, urinary tract – reproductive organs) (N00-N99).
- Epididymitis (epididymitis; 28.4%) or epidydymo-orchitis (epididymitis of the testis; 28.7%), viral or bacterial (adults).
- Fournier’s gangrene (synonym: Fournier’s disease) – rare special form of necrotizing fasciitis in the genito-perineal area with high lethality (7-75%).
- Funiculitis – inflammation of the spermatic cord (funiculus spermaticus).
- Funiculocele – cyst (fluid-filled cavity; the size of a bean to an olive) caused by accumulation of tissue fluid in the region of the spermatic cord (lat. Funiculus spermaticus).
- Testicular torsion (twisting of the testicular vessels), which causes the blood supply to be interrupted; often occurs during sleep (50%), but also during sports/games; usually affects children. Caution. An older age does not exclude a testicular torsion! (see if necessary under the clinical picture: testicular torsion)Special forms are:
- Intermittent testicular torsion: after acute pain symptoms, there is a rapid improvement in findings (Doppler sonography shows a hyperperfused testis).
- Neonatal testicular torsion. The torsion event is usually prenatal (before birth); in about 100% of cases, there is a severely damaged testicular parenchyma (testicular tissue)
Any acute scrotum is a testicular torsion until the definitive exclusion of this diagnosis! (0.3% in adults)
- Hydatid torsion – circulatory disturbance of small appendices (testicular appendages) of the testis or epididymis due to torsion (twisting); these are testicular appendages originating from the Müller duct, Wolff’s duct or the mesonephritic tubule.Differentialdiagnostic is the pain maximum often directly above the testis to be detected; diaphanoscopy (fluoroscopy of body parts through a light source placed on; here: Scrotum (scrotum)): often so-called “blue dot sign” (bluish shimmering structures), as an indication of a circulatory disorder of the appendices; pathognomonic; occurrence only in about 20% of cases); frequency peak: 10 to 12 years; in prepubertal boys more common than testicular torsion.
- Hydrocele (water hernia; 0.3% in adults).
- Incarcerated scrotal hernia (testicular hernia) – indirect hernia is present in 60-70% of patients with open processus vaginalis; in direct inguinal hernia, where the hernial orifice is medial to the epigastric vessels, incarcerations are less common at 30-40%.
- Orchitis (testicular inflammation), viral or bacterial (10.3% in adults).
- Necrotizing fasciitis at the scrotum (Fournieŕ sches gangrene) – foudroyant life-threatening infection of the skin, subcutis (subcutaneous tissue) and fascia with progressive gangrene; it is often patients with diabetes mellitus or other diseases that lead to circulatory disorders or reduced immune defenses
- Scrotal edema (accumulation of fluid in the scrotum), acute; in prepubertal boys; frequency peak: 5-6 years; most common cause: local allergic phenomenon (idiopathic, insect bite).
- Scrotal edema (accumulation of fluid in the scrotum), acute; in prepubertal boys; incidence (frequency of new cases) in childhood and adulthood: >10%; most common cause: local allergic phenomenon (insect bite) or acute idiopathic scrotal edema (AISE): peak incidence: 5-11 years; clinical presentation: swelling and redness of the scrotum, one-third unilateral (unilateral) and two-thirds bilateral (bilateral); possibly. The swelling is usually painless, but there may be a slight pain due to pressure and tension; no special therapy is required because AISE is a self-limiting disease, i.e. the disease heals on its own. Note: The diagnosis of acute idiopathic scrotal edema is a diagnosis of exclusion i.e. the first priority is the inclusion or exclusion of testicular torsion!
- Scrotal abscess (accumulation of pus in the scrotum) / abscesses (0.7% in adults).
- Scrotal emphysema – accumulation of air in the scrotum.
Injuries, poisonings and other consequences of external causes (S00-T98).
- Scotal trauma/testicular trauma (open or blunt trauma).
- Dislocation of the testicles
- Testicular rupture – rupture of the testicle, due to an injury.
- Hematocele – bleeding into the testicle caused by blunt force.
- Penetrating scrotal trauma
