A previously healthy 15-year-old boy is brought to - seaside

[ArchivalUser]

A previously healthy 15-year-old boy is brought to your emergency department with a 3-hour history of right testicular pain. He states that the pain began after football practice this afternoon. He does not remember any trauma to the area during practice. He appears to be in a significant amount of pain. His blood pressure is 128/80 mm Hg and his pulse is 110/min. Physical examination shows an erythematous, swollen right scrotum with significant tenderness to palpation on that side. You also note that the cremasteric reflex is absent on the right side. A urinalysis was sent from triage and is negative. The most appropriate next step is a
A. CT of the abdomen
B. surgical consultation
C. urine for gonorrhea and chlamydia
D. testicular biopsy
E. voiding cystourethrogram

[ArchivalUser]

correct answer is B

[ArchivalUser]

E

[ArchivalUser]

surgical consult

[ArchivalUser]

E,

[ArchivalUser]

testicular torsion: B

[ArchivalUser]

bbbb

[ArchivalUser]

B

[ArchivalUser]

B it may be due to torsion

[ArchivalUser]

The correct answer is B.

The patient has torsion of the right testicle. In any patient with testicular swelling and pain, surgical consultation should be sought as soon as possible because delay in the diagnosis of testicular torsion can result in loss of that testis due to absent blood flow. If the diagnosis is delayed >6 hrs without intervention, there is a significant risk of necrosis of that testis. An ultrasound with color Doppler will evaluate the blood flow to the affected testis and also assess the morphology of the testicle. However, it often delays the management of the condition, which could have disastrous effects.