Left Scrotal Pain in an 18-yr-old Man

Physical Examination

  • General appearance: Appears nontoxic but seems uncomfortable on the exam bed.

  • Vital signs:
  • Temperature 37° C
  • Pulse 99/min
  • BP 120/60 mm Hg
  • Respirations: 16/min
  • Height: 5' 8" (1.73 m)
  • Weight: 160 lb (73 kg)
  • Height: 5' 8" (1.73 m)
  • BMI: 24.1

  • Skin: Warm and dry to the touch.

  • HEENT: Normocephalic without evidence of trauma.

  • Pulmonary: Breath sounds are present and equal bilaterally. No stridor, rales, or wheezing.

  • Cardiovascular: Heart rate is regular. Radial pulses are present and equal bilaterally.

  • Gastrointestinal: Abdomen appears nondistended; no ecchymoses or other visible lesions. Bowel sounds are normal. Abdomen is soft, nontender to light and deep palpation with no guarding, rigidity, or rebound.

  • Genitourinary: Circumcised penis with no discharge. Left side of scrotum is swollen and extremely tender. It is difficult to palpate left testis secondary to extreme pain. Right testis has normal texture and is normal on palpation but does have a horizontal lie. No tenderness or fullness over the inguinal canals. Negative left cremasteric reflex.

  • Musculoskeletal: No costovertebral angle tenderness.

  • Neurologic: Unremarkable

  • Mental status: Alert and oriented to person, place, time, and event.