Testicular emergencies.
What is this deformity called that increases your chance of developing torsion of the testis?
In the "Bell clapper" deformity the testis lacks its normal attachment to the tunica vaginalis. It is therefore more mobile and the testis tends to lie transverse. It occurs in about 1 in 125 males.
This man has been diagnosed with gonococcal urethritis. He now presents with a painful, warm scrotum and testis. What is the likely diagnosis?
In these cases the testis is almost always involved making it epididymo-orchitis rather than simply epididymitis. He will need IV antibiotics, analgesia and a scrotal ultrasound.
This man presented with a tender right testis. Examination shows this tender area on the superior pole of the testis. It has a blueish tinge. What is the problem?
This is the "blue dot" sign where the appendix of the testis (also known as Hydatid of Morgagni) twists. It generally occurs in 7 to 12 yr olds and is tender. The blue dot sign seen in about 1/3 of cases. The cremaster reflex is still present and US shows normal testis flow. If there is any doubt of the diagnosis they go to OT and some urologists will go anyway for ongoing analgesia reasons.
A 25yr old man presents with a dragging ache in his left testis for 2 months. No discharge. Palpation feels like a "Bag of Worms". What does he have which can be seen on ultrasound?
Varicoceles are dilations of the pampiniform plexus (collection of veins). Sudden onset, especially right sided, varicoceles should be a red flag to investigate the retroperitoneal space (eg Renal cell Ca) that might be causing the obstruction. Otherwise urologists usually fix them operatively as an outpatient.
What type of testicular cancer did Lance Armstrong have?
Seminomas make up more than 50% of testicular cancers but he had a cancer that comes from germ cells. On diagnosis it had metastasized to his brain but with chemotherapy it was "cured". He then won 7 Tour de France races with the help of a few drugs---and generally went from hero to zero (although he did raise over $500 million for cancer research and gave $6.5 million himself).
This is an ultrasound of Doppler flow of a young man testes. He presented 4 hours after developing pain in his left testis. What does it show?
On the scale on the right you can see it is looking for low flow---so it will pick up just about any flow. There is bugger all flow in the left testis consistent with a torsion. If he gets to OT before 6 hours of onset of the pain he has an excellent chance of keeping his testis. If > 24hrs--sure he might keep his testis but in a jar.
The picture is trying to describe how to manually de tort a torted testis. Which of the following statements is correct about the manouvre?
Firstly you would have to remove his pants. Mostly (about 80% of the time) torsion rotates medially so you have to go laterally to attempt de torsion. Its painful and usually unsuccessful as the torsion is often > 360 degrees. I suppose if you were in the middle of no where and help is hours away it would be worth a go,
This young man has just suffered a bout of mumps and has presented with a painful right testis. What does the US image show?
Orchitis--unilateral or bilateral is a classic complication of mumps. There are multiple potential causes of orchitis including STIs, UTIs, multiple other viruses, TB to name a few.
Following this below you belt injury what does the US show?
OK---The s image is not of the boxer---but it could have been. Ruptures need to go to OT, contusions are often observed. If testicular trauma arrives in your ED get an US and consult urology to be certain.
Which one of the following men has both testes?
Schwarzeneggar lost one apparently due to steroid use. Mark Latham had one removed because of testicular cancer. Bruce Lee had an undescended testis.
Joe Root was struck repeatedly in the groin during the recent Ashes series but by all counts retains both of his testes.