Scrotal pain in the absence of torsion; need for vigilance

• Published in: Emergency medicine journal : EMJ Vol. 20; no. 1; pp. 104 - 105
• Main Authors: Venketraman, S, Gray, J P, Evans, P A
• Format: Journal Article
• Language: English
• Published: England BMJ Publishing Group Ltd and the British Association for Accident & Emergency Medicine 01.01.2003; BMJ Publishing Group LTD; BMJ Group
• Subjects: Adult; Antibiotics; Case Report; Diagnosis, Differential; epididymitis; Epididymitis - diagnostic imaging; Humans; Male; microlithiasis; Pain; Pain - etiology; Scrotum - diagnostic imaging; Spermatic Cord Torsion - diagnostic imaging; Ultrasonic imaging; Ultrasonography; Urology
• ISSN: 1472-0205; 1472-0213
• DOI: 10.1136/emj.20.1.104

Epididymitis is a common presentation of acute testicular pain seen in the emergency department, the differential diagnosis being testicular torsion. The vast majority of young men with epididymitis have an infective aetiology and this settles with antibiotic treatment. The clinical course of a patient who presented with testicular pain is described. At ultrasonography, the patient was found to have the uncommon condition of testicular microlithiasis, a condition that has been linked to malignant disease. Emergency doctors should be aware of the potential consequences of returning scrotal pain consistent with epididymitis to the community on antibiotic treatment alone. All patients with probable epididymitis should have either a scrotal ultrasound or specialist follow up.