Written by Garry Martin, MD and images/edited by Hunter Louis MD, RDMS
History:
HPI: Mr. Greg Onads is a 24 y/o male without significant past medical history who presents to the ED with left sided testicular ‘pressure’. Further history reveals that this pressure has been of gradual onset over the past year or so, now to the point where he finds most days uncomfortable. At first it only bothered him after long days of either standing on his fit or doing a lot of moving. Mr. Onads states that the pain is localized to his testicle and that he does not have any groin pain, denies heavy abnormal lifting or any trauma to the area. Upon questioning he does state that he and his wife have been trying to conceive a child for the past 14 months without success and he now worries that his pressure is from a growing cancer in his testicle that is preventing him from having any more children. Pt also denies dysuria, discharge, STDs, orchitis, prescription medications as this is his first visit to a physician for this problem.
PMHx: unremarkable
Soc Hx: occasional tobacco, denies etoh, drugs
Meds: none
Allergies: none
ROS: negative fever, chills, nausea, vomiting, diarrhea, change in bowel habits, chest pain, wt. loss, SOB.
Image of testicle:
Physical Exam
Vital Signs – T = 97.4, HR = 66, BP =112/70, RR = 12
HEENT – OP clear, no nasal discharge, TM clear w/ sharp LR. EOMI, PERRLA.
Neck – Supple, nontender, trachea midline, no thyromegaly
Chest – CTAB
CV – RRR, no G/R/M, nl S1/S2, 2+ pulses in the periphery bilaterally
GI – abdomen S/NT/ND, +BS, no organomegaly, no flank tenderness
MSK – no redness/warmpth/erythema/fluctuance noted in jointsLymphatics – No C/C/E
GU – no tenderness in right testicle noted. Left Testicle shows remarkable cylindrical swelling on the left side giving it a bluish-grey appearance. Mr. Onads has mild tenderness to palpation in the posterior superior aspect of his left testicle. No blue dot sign present. No ulcers, rash or fungating masses appreciated. Hernia exam reveals no masses bilaterally with valsalva/cough.
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