Episode 87 – RLR – Scrotal Pain

Episode description

Reza and Rabih talk through a case

RLR #3 – Scrotal pain 
A 75-year-old man with a history of Alzheimers dementia presented with 2 weeks of bilateral scrotal pain. Genital exam was unremarkable. Chest radiography revealed a right lower lobe opacity and computed tomography of the abdomen was notable for diffuse retroperitoneal lymphadenopathy. Biopsy was performed of a mediastinal lymph node which revealed findings consistent with metastatic small-cell lung cancer.

Teaching Points:

• Acute scrotal pain is a common complaint encountered in the emergency department and can be caused by pathology within the scrotum, abdomen (i.e., inguinal hernia), or referred from the retroperitoneum. The most common causes of acute scrotal pain include torsion of the testicular appendage, epididymitis, and testicular torsion. The initial evaluation is focused on excluding the presence of testicular torsion (a surgical emergency) by exam and, often times, doppler ultrasonography.