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History. 19-year-old male with acute right scrotal pain for the last 5 hours No fever, dysuria, nausea and vomiting No previous pain episodes No history of trauma Past history: Unremarkable. Physical exam. T = 37.2, P = 72, BP = 105/74 Chest, abdomen, and extremities are all normal

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history
History
  • 19-year-old male with acute right scrotal pain for the last 5 hours
  • No fever, dysuria, nausea and vomiting
  • No previous pain episodes
  • No history of trauma
  • Past history: Unremarkable
physical exam
Physical exam
  • T = 37.2, P = 72, BP = 105/74
  • Chest, abdomen, and extremities are all normal
  • Penis: Uncircumcised, no discharge or lesions
  • Left testis: Normal
  • Right scrotum: Swollen, erythematous and extremely tender
laboratory
Laboratory
  • U/A: 5 WBC, 0 RBC, Mod. Bacteria
  • CBC: WBC 9.6, Hct 39
differential diagnosis
Differential Diagnosis
  • Spermatic cord torsion
  • Torsion of testicular appendage
  • Epididymitis / orchitis
  • Trauma
  • Malignancy
  • Idiopathic
management
Management
  • Epididymitis - Antibiotics
  • Torsion of appendage - Observation
  • Torsion of cord - Exploration
  • Trauma - Exploration
  • Malignancy - Exploration
epididymitis orchitis
Epididymitis/Orchitis
  • Etiology
    • Sexually active
      • N. Gonorrhea
      • Chylamidia
      • Ureaplasma urealyticum
    • Prepubertal
      • E. Coli
infection management
Infection: Management
  • STD
    • Azithromycin
    • Metronidazole
  • Prepubertal
    • Trim/sulfa
    • Cephalosporine
torsion of appendage13
Torsion of Appendage
  • Observation (if you can be certain of the diagnosis)
  • Exploration if you can’t rule out spermatic cord torsion
acute scrotum summary
Acute Scrotum – Summary
  • Spermatic cord torsion most common cause
  • Doppler ultrasound most accurate noninvasive imaging study
    • 5% false negative
  • Suspect spermatic cord torsion
    • Immediate exploration
history15
History
  • 42-year-old white male w/ painful erection >6 hours
  • Past History: depression
  • Medications: trazadone
slide16
Exam
  • T = 37, P = 78, BP = 126/82
  • Penis: erect with tumescence of corpora cavernosa, soft glans and ventrum
management17
Management
  • Aspiration / Irrigation
    • Blood gas on aspirate
    • pH = 7.4, pO2 = 38
  • Phenylephrine Irrigation
    • Monitor patient (BP, pulse)
history18
History
  • 26-year-old white male suffered “crossbar” injury
  • Erection >5 hours
  • Past History: Negative
slide19
Exam
  • T = 37, P = 78, BP = 126/82
  • Penis: erect
  • Aspirate - Bright red blood
    • pH = 7.0, pO2 = 86
high flow priapism
High-flow Priapism
  • History of trauma
  • Diagnosis:
    • Duplex Doppler ultrasound
    • Arteriography
  • Management: Embolization
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