Author: Victoria Chen, MD
Co Author #1: Neil Mathews, IV, MD
Editor: Sarah Kinsella, MD
Senior Editor: Mandeep Ghuman, MD
A healthy 20 year-old male professional hockey player presented with worsening pain and swelling of his left testicle 3 days after sustaining a groin injury.
He was not wearing protective equipment when he took a puck to the groin while trying to block a shot during an away game. He was evaluated by his athletic trainer and the team physician of the opposing team during intermission. At that time, the athlete was noted to have swelling and bruising of his left testicle on exam. He was allowed to return to play, with instructions on when to seek further evaluation. He attempted to skate in the following period but sat out due to worsening pain. After the game, he presented to the local emergency department. Physical exam at that time revealed a tender left testicle that was approximately twice the size of the contralateral side. To rule out testicular rupture, an ultrasound with Doppler revealed a normal right testis while the left demonstrated a subcapsular hematoma, hemorrhagic hydrocele, and no flow to the lower half of the testicle. The emergency physician consulted urology who recommended conservative management with pain medication and ice and no surgical intervention. The athlete was admitted overnight for observation and was discharged the next day with instructions to follow-up with a urologist when he returned home.
On day 3 post-injury, after returning home, the athlete underwent a follow-up evaluation by a urologist.
No significant past medical history
Vital signs normal.
The patient is a well-developed caucasian male in no acute distress.
HEENT, cardiovascular, respiratory, neurologic, abdominal, musculoskeletal, and skin exams were normal.
Penis: No lesions, tenderness, curvature, plaques, without phimosis or paraphimosis. Meatus is orthotropic without discharge.
Testes: Descended bilaterally. Left testis is very tender, unable to fully examine due to discomfort. Scrotal skin is normal without erythema. Right testis is normal without palpable mass. No hydroceles.
Groin: No palpable inguinal hernias, no adenopathy.
Click here to continue. Challenge yourself by writing down a broad differential diagnosis before moving to the next slide.