A 4-Year-Old Boy Is Brought to the Clinic for Evaluation

A 4-year-old boy is brought to the clinic for evaluation of scrotal swelling.  His mother first noticed swelling near his right testicle after giving him a bath 2 days ago.  It has not been painful, and the patient has had no difficulty urinating.  Neither the mother nor the patient recalls specific trauma to the area.  The patient is otherwise healthy and takes no medications.  Temperature is 37.1 C (98.8 F) .  Initial blood pressure is 160/96 mm Hg; a repeat assessment is 158/92 mm Hg.  Physical examination shows an alert child who is active and cooperative.  The abdomen is nontender, and bowel sounds are present.  Genitourinary examination reveals Tanner stage 1 development with bilateral testicles within the scrotum.  There is a palpable, nontender, soft, coiled mass superior to the right testicle.  When a light is placed at the base of the scrotum, the mass does not transilluminate.  In addition, the mass does not decrease in size when the patient is supine.  Urinalysis reveals no blood, nitrites, or leukocyte esterase.  Which of the following is the best next step in management of this patient?

A) Biopsy of the scrotal mass
B) Reassurance and observation only
C) Surgical orchiectomy
D) Ultrasound of the abdomen
E) Urine culture

Correct Answer:

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