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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 • 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 • Penis: Uncircumcised, no discharge or lesions • Left testis: Normal • Right scrotum: Swollen, erythematous and extremely tender
Laboratory • U/A: 5 WBC, 0 RBC, Mod. Bacteria • CBC: WBC 9.6, Hct 39
Differential Diagnosis • Spermatic cord torsion • Torsion of testicular appendage • Epididymitis / orchitis • Trauma • Malignancy • Idiopathic
Management • Epididymitis - Antibiotics • Torsion of appendage - Observation • Torsion of cord - Exploration • Trauma - Exploration • Malignancy - Exploration
Bell-clapper Management – Exploration
Epididymitis/Orchitis • Etiology • Sexually active • N. Gonorrhea • Chylamidia • Ureaplasma urealyticum • Prepubertal • E. Coli
Infection: Management • STD • Azithromycin • Metronidazole • Prepubertal • Trim/sulfa • Cephalosporine
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 • Spermatic cord torsion most common cause • Doppler ultrasound most accurate noninvasive imaging study • 5% false negative • Suspect spermatic cord torsion • Immediate exploration
History • 42-year-old white male w/ painful erection >6 hours • Past History: depression • Medications: trazadone
Exam • T = 37, P = 78, BP = 126/82 • Penis: erect with tumescence of corpora cavernosa, soft glans and ventrum
Management • Aspiration / Irrigation • Blood gas on aspirate • pH = 7.4, pO2 = 38 • Phenylephrine Irrigation • Monitor patient (BP, pulse)
History • 26-year-old white male suffered “crossbar” injury • Erection >5 hours • Past History: Negative
Exam • T = 37, P = 78, BP = 126/82 • Penis: erect • Aspirate - Bright red blood • pH = 7.0, pO2 = 86
High-flow Priapism • History of trauma • Diagnosis: • Duplex Doppler ultrasound • Arteriography • Management: Embolization