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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. T = 37.2, P = 72, BP = 105/74 Chest, abdomen, and extremities are all normal

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History

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  1. 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

  2. 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

  3. Exam

  4. Laboratory • U/A: 5 WBC, 0 RBC, Mod. Bacteria • CBC: WBC 9.6, Hct 39

  5. Differential Diagnosis • Spermatic cord torsion • Torsion of testicular appendage • Epididymitis / orchitis • Trauma • Malignancy • Idiopathic

  6. Management • Epididymitis - Antibiotics • Torsion of appendage - Observation • Torsion of cord - Exploration • Trauma - Exploration • Malignancy - Exploration

  7. Imaging-Doppler Ultrasound

  8. Bell-clapper Management – Exploration

  9. Management – Orchiopexy

  10. Epididymitis/Orchitis • Etiology • Sexually active • N. Gonorrhea • Chylamidia • Ureaplasma urealyticum • Prepubertal • E. Coli

  11. Infection: Management • STD • Azithromycin • Metronidazole • Prepubertal • Trim/sulfa • Cephalosporine

  12. Torsion of Appendage

  13. Torsion of Appendage • Observation (if you can be certain of the diagnosis) • Exploration if you can’t rule out spermatic cord torsion

  14. 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

  15. History • 42-year-old white male w/ painful erection >6 hours • Past History: depression • Medications: trazadone

  16. Exam • T = 37, P = 78, BP = 126/82 • Penis: erect with tumescence of corpora cavernosa, soft glans and ventrum

  17. Management • Aspiration / Irrigation • Blood gas on aspirate • pH = 7.4, pO2 = 38 • Phenylephrine Irrigation • Monitor patient (BP, pulse)

  18. History • 26-year-old white male suffered “crossbar” injury • Erection >5 hours • Past History: Negative

  19. Exam • T = 37, P = 78, BP = 126/82 • Penis: erect • Aspirate - Bright red blood • pH = 7.0, pO2 = 86

  20. High-flow Priapism • History of trauma • Diagnosis: • Duplex Doppler ultrasound • Arteriography • Management: Embolization

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