Differential diagnosis of painless scrotal swelling in children

Mass	Palpation	Transilluminates?	Increases with Valsalva maneuver?
Tumor	Firm	No	No
Varicocele	"Bag of worms"	No	Yes
Noncommunicating hydrocele	Fluid-filled	Yes	No
Communicating hydrocele	Fluid-filled	Yes	Yes
Inguinal hernia without incarceration	Nontender, reducible mass	No	Yes
Scrotal edema (insect bite or sign of generalized edema)	Bilateral scrotal swelling, soft	No	No
Spermatocele	Small, soft, and localized cyst	Yes	No

Reference:

Kapphahn C, Schlossberger N. Diagnostic approach to scrotal masses. Adolescent Health Update 1992; 5:1.

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