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Acute Testicular Torsion
The classic presentation of testicular torsion is a younger person, less than 40 years old with unilateral pain and swelling of the testes. It's incredibly rare to see someone over the age of 40 with their first episode of torsion,. I would put lots of money on this being an epidemicitis or an archalgia over a torsion. And I'd love to get an ultrasound before exploring that person, if possible, in a timely fashion.