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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.

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Presentation on theme: "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."— 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 Management – Exploration Bell-clapper

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 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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