Abstract
HISTORY: 20-year-old male catcher presented for acute evaluation of an injury to his groin during a minor league baseball game. A foul ball hit him on the right side of his groin. He complained of severe pain in his scrotum and abdomen. He was most comfortable in a supine position with his legs elevated. After rest and indirect icing he began to feel better. By the time the game was over, he was feeling much better. His scrotal pain was improving, his nausea and abdominal pain had nearly resolved, and he was able to ambulate with minimal pain. He was also able to urinate normally and denied dysuria or hematuria. After repeat evaluation, he was allowed to return home with red flag instructions. The working diagnosis was right testicular contusion.
At 0834, he presented to the ED with increasing testicular pain, rated 10/10. He denied hematuria, dysuria or difficulty with urination. He denied fever and chills. He also reported a history of contralateral testicular torsion and repair.
PHYSICAL EXAMINATION:
Initial - GU (mildly edematous scrotum, generalized tenderness to palpation of his scrotum/testicles but right-sided tenderness was greater, palpation of his scrotum/testicle caused radiating pain into the right upper abdomen, intact testicular shape and firmness, testicular artery pulses were 3+ bilaterally. No hematomas were palpable. Urethra appeared intact. No bladder tenderness. No ecchymosis or lacerations. Penis wnl, Abdomen (soft, mildly tender diffusely, no guarding, normal bowel sounds) ED - Vitals wnl, General (obvious pain), Abdomen wnl, GU (right scrotum - edematous/ecchymotic/firm/severely tender; penis wnl)
PHYSICAL EXAMINATION:
Testicular contusion/hematoma
Scrotal hematoma
Testicular fracture
Epididymis fracture
Testicular torsion
Bladder/urethral injury
TEST AND RESULTS:
WBC 13.27, UA (no blood or bacteria)
Testicular Ultrasound - 1.6x 1.5 cm right testicular hematoma with edema of the adjacent testicular tissue and probable disruption of the adjacent tunica
FINAL WORKING DIAGNOSIS:
Tunica albuginea tear of right testicle
TREATMENT AND OUTCOMES:
1. STAT urology consult lead to right scrotal surgical exploration/repair. Findings: dark testicle from old blood and small tear in the tunica albuginea.
2. At follow up 6 days after his surgery, he was recovering well.
At 0834, he presented to the ED with increasing testicular pain, rated 10/10. He denied hematuria, dysuria or difficulty with urination. He denied fever and chills. He also reported a history of contralateral testicular torsion and repair.
PHYSICAL EXAMINATION:
Initial - GU (mildly edematous scrotum, generalized tenderness to palpation of his scrotum/testicles but right-sided tenderness was greater, palpation of his scrotum/testicle caused radiating pain into the right upper abdomen, intact testicular shape and firmness, testicular artery pulses were 3+ bilaterally. No hematomas were palpable. Urethra appeared intact. No bladder tenderness. No ecchymosis or lacerations. Penis wnl, Abdomen (soft, mildly tender diffusely, no guarding, normal bowel sounds) ED - Vitals wnl, General (obvious pain), Abdomen wnl, GU (right scrotum - edematous/ecchymotic/firm/severely tender; penis wnl)
PHYSICAL EXAMINATION:
Testicular contusion/hematoma
Scrotal hematoma
Testicular fracture
Epididymis fracture
Testicular torsion
Bladder/urethral injury
TEST AND RESULTS:
WBC 13.27, UA (no blood or bacteria)
Testicular Ultrasound - 1.6x 1.5 cm right testicular hematoma with edema of the adjacent testicular tissue and probable disruption of the adjacent tunica
FINAL WORKING DIAGNOSIS:
Tunica albuginea tear of right testicle
TREATMENT AND OUTCOMES:
1. STAT urology consult lead to right scrotal surgical exploration/repair. Findings: dark testicle from old blood and small tear in the tunica albuginea.
2. At follow up 6 days after his surgery, he was recovering well.
| Original language | English (US) |
|---|---|
| Journal | Medicine and Science in Sports and Exercise |
| State | Published - May 2013 |