From the Guidelines
A mild left scrotal seroma can be identified during physical examination, characterized by a soft, non-tender, fluctuant swelling in the left hemiscrotum that may feel like a fluid collection. When examining the scrotum, it's essential to differentiate a seroma from other scrotal conditions like hydrocele, hematoma, or hernia by assessing for tenderness, ability to reduce the swelling, and relationship to the testicle 1. The swelling typically transilluminates (glows when a light is placed behind it) because seromas contain clear serous fluid. Unlike a hydrocele, a seroma usually develops following trauma, surgery, or inflammation, representing a collection of lymphatic fluid or serum without blood components.
Some key points to consider during the physical examination include:
- Assessing for tenderness and fluctuance of the swelling
- Evaluating the ability to reduce the swelling
- Examining the relationship of the swelling to the testicle
- Checking for transillumination of the swelling
- Considering the patient's medical history, including any recent trauma, surgery, or inflammation.
Mild scrotal seromas often resolve spontaneously within weeks with conservative management, including scrotal support, rest, and anti-inflammatory medications if needed 1. If the seroma is causing significant discomfort or fails to resolve, needle aspiration might be considered, though recurrence is common unless the underlying cause is addressed. Ultrasound examination can be used to confirm the diagnosis and rule out other scrotal conditions, as it is the diagnostic modality of choice for palpable scrotal abnormalities 1.
From the Research
Identification of Mild Left Scrotal Seroma on Physical Exam
- A physical examination can reveal signs of scrotal seroma, such as a fluctuant mass or swelling in the scrotum 2.
- However, it may be challenging to distinguish between a seroma and other scrotal pathologies, such as a hydrocele or testicular tumor, based on physical examination alone 2.
- Imaging modalities like ultrasound are often necessary to confirm the diagnosis and rule out other potential causes of scrotal swelling 2, 3.
Characteristics of Scrotal Seroma
- Scrotal seroma is a collection of fluid in the scrotum, which can occur as a complication of hernia repair or other surgical procedures 4, 5, 6.
- Seromas can be asymptomatic or symptomatic, with symptoms ranging from mild discomfort to severe pain and swelling 5.
- The size and severity of the seroma can vary, with some cases requiring surgical intervention or drainage 5, 6.
Diagnostic Challenges
- Physical examination may not be sufficient to diagnose scrotal seroma, especially in mild cases or when the seroma is small 2.
- Imaging modalities like ultrasound are essential for confirming the diagnosis and evaluating the size and severity of the seroma 2, 3.
- The diagnostic performance of ultrasound in scrotal trauma is not fully established, and advanced techniques like contrast-enhanced ultrasound and elastography may be useful in equivocal cases 3.