Question of the Week

For July 28, 2015

A 30-year-old man presents with a progressively enlarging left-sided scrotal mass, which he first noticed several weeks ago and describes as nontender but slightly uncomfortable.

On physical examination, the patient’s vital signs are normal. Head, neck, cardiovascular, and respiratory examination findings are within normal limits, and an abdominal examination is unremarkable. Examination of the scrotum reveals a left-sided varicocele, with a classic “bag-of-worms” feel on palpation. It is equally present in both the standing and the supine position.

What is the most appropriate next diagnostic step in this case?

Measure alpha-fetoprotein and human chorionic gonadotropin levels
Measure serum testosterone and luteinizing-hormone levels
Order an ultrasound of the scrotum
Obtain CT of the abdomen and pelvis
Advise wearing loose-fitting underwear and have the patient return for follow-up in 2 to 3 months