Intended for healthcare professionals

Practice 10-Minute Consultation


BMJ 2011; 342 doi: (Published 13 April 2011) Cite this as: BMJ 2011;342:d1543
  1. A Stewart, foundation two doctor1,
  2. S S Ubee, specialist registrar in urology2,
  3. H Davies, general practitioner, partner3
  1. 1Royal Liverpool and Broadgreen University Hospital Trust, Liverpool L7 8XP, UK
  2. 2Heart of England NHS Foundation Trust, Birmingham B9 5SS, UK
  3. 3Green Lane Medical Centre, Tuebrook, Liverpool L13 7DY, UK
  1. Correspondence to: A Stewart a.j.stewart{at}

A 22 year old student presents with a three day history of painful swollen left scrotum. He has also noticed a burning sensation when he passes urine.

What you should cover

There are three main diagnoses to consider in this patient. Epididymo-orchitis is the commonest cause of acute scrotal pain and refers to inflammation of the epididymis and testis. However, the most important differential diagnosis that should be excluded is testicular torsion; this is a surgical emergency where prompt intervention is required. Trauma is an important diagnosis to think about in all patients and is usually suggested by the history.

Two much rarer causes of acute scrotal pain and/or swelling include a rapidly growing testicular tumour, which in most cases will present as a painless testicular lump. Idiopathic scrotal oedema usually presents in childhood with bilateral oedema and bruising over the scrotal skin. The testes should not be tender on examination.

Taking history

  • Onset: insidious presentation suggests infection. Sudden onset of symptoms should raise suspicions of torsion

  • Pain: usual presentation of epididymo-orchitis is with unilateral -scrotal pain that may radiate to the groin

  • Swelling

  • Any recent trauma

  • Urinary symptoms: may be present if …

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