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History

• 19-year-old male with acute rightscrotal pain for the last 5 hours

• No fever, dysuria, nausea andvomiting

• No previous pain episodes

•No history of trauma

• Past history: Unremara!le

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Physical e"am

• # $ %&'(, P $ &(, )P $ 1*5+&

• hest, a!domen, and e"tremities are

all normal• Penis: Uncircumcised, no discharge

or lesions

• .eft testis: Normal• /ight scrotum: 0wollen,

erythematous and e"tremely tender 

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"am

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.a!oratory

• U+2: 5 3), * /), 4od' )acteria

• ): 3) 9', Hct %9

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6ifferential 6iagnosis

• 0permatic cord torsion

• #orsion of testicular appendage

• pididymitis + orchitis

• #rauma

•

4alignancy• 7diopathic

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4anagement

• pididymitis - 2nti!iotics

• #orsion of appendage - 8!servation

• #orsion of cord - "ploration

• #rauma - "ploration

• 4alignancy - "ploration

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7maging-6oppler Ultrasound

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4anagement "ploration

• )ell-clapper 

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4anagement 8rchiope"y

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pididymitis+8rchitis

• tiology

 – 0e"ually active

• N' onorrhea• hylamidia

• Ureaplasma urealyticum

 – Prepu!ertal

• ' oli

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7nfection: 4anagement

• 0#6

 – 2;ithromycin

 – 4etronida;ole

• Prepu!ertal

 – #rim+sulfa

 – ephalosporine

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#orsion of 2ppendage

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#orsion of 2ppendage

• 8!servation <if you can !e certain of

the diagnosis=

• "ploration if you can>t rule out

spermatic cord torsion

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2cute 0crotum 0ummary

• 0permatic cord torsion most

common cause

• 6oppler ultrasound most accuratenoninvasive imaging study

 – 5? false negative

• 0uspect spermatic cord torsion

 – 7mmediate e"ploration

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History

• (-year-old white male w+ painful

erection @ hours

• Past History: depression

• 4edications: tra;adone

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"am

• # $ %&, P $ &A, )P $ 1(+A(

• Penis: erect with tumescence of

corpora cavernosa, soft glans and

ventrum

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4anagement

• 2spiration + 7rrigation

 – )lood gas on aspirate

 – pH $ &', p8( $ %A

• Phenylephrine 7rrigation

 – 4onitor patient <)P, pulse=

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"am

• # $ %&, P $ &A, )P $ 1(+A(

• Penis: erect

•

2spirate - )right red !lood – pH $ &'*, p8( $ A

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High-flow Priapism

• History of trauma

• 6iagnosis:

 – 6uple" 6oppler ultrasound

 – 2rteriography

• 4anagement: m!oli;ation