1 / 20

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

fell
Download Presentation

History

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript

  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

More Related