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Routine Drug Screening Leads To Unusual Diagnosis - Page #1
 

Author: Victoria Oakes, MD, MBA
Co Author #1: Benjamin Marrone
Co Author #2: James Barrett
Senior Editor: Christian Fulmer, DO, FAMSSM
Editor: Julia Rawlings, MD

Patient Presentation:
A college-age basketball player presented for review of labs obtained during routine World-Anti Doping Agency testing for an international league.

History:
A college-age basketball player presented in late August for review of abnormal lab results that had been obtained during random World Anti-Doping Agency (WADA) testing over the summer while attempting to play for an international league. He was informed of a slightly elevated human chorionic gonadotropin (hCG) that was elevated enough to disqualify him from playing with the league. He was instructed to follow up with his primary care physician upon returning home for further evaluation. When questioned, the patient denied noticing any masses on his testicles. He also denied weight loss, fatigue, anorexia, night sweats, abdominal pain, testicular pain or urinary symptoms. The patient does have a history of left varicocele repair in adolescence but has not had any recurrent varicoceles or other concerns. There was no other significant personal past medical history or family medical history.

Physical Exam:
General: Well-appearing, no acute distress, appropriate weight
Abdominal: No hernia in the right or left inguinal areas, no tenderness to palpation
Genitourinary:
-Right Testes: No tenderness to palpation, mass, swelling, testicular hydrocele or varicocele
-Left Testes: Firm, heterogeneous, non-tender lesion in the left testicle and associated varicocele. Normal epididymis. Testicle is freely mobile within the scrotum. No tenderness to palpation, swelling, or testicular hydrocele.
Musculoskeletal: Normal range of motion of all extremities
Skin: Warm, dry. No erythema, rashes, skin changes, or other abnormalities
Lymphadenopathy: No inguinal adenopathy on either right or left side

Click here to continue. Challenge yourself by writing down a broad differential diagnosis before moving to the next slide.

NOTE: For more information, please contact the AMSSM, 4000 W. 114th Street, Suite 100, Leawood, KS 66211 (913) 327-1415.
 

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