An 80-year-old gentleman complains of testicular pain that had its onset 3 days ago and has built since to prevent sleep the night before this visit. On examination the testicle seems on palpation to be irregular in shape and quite tender. The scrotal contents are difficult to differentiate. The patient’s temperature is 100.8F. The urinalysis demonstrates 20 to 30 white blood cells/high-power field. Which of the following is the most likely diagnosis?
(A) Epididymitis
(B) Testicular trauma
© Torsion of the testicle
(D) Orchitis
(E) Testicular cancer
The answer is A. Epididymitis is well described in the vignette. Although the testicular anatomy may be difficult to differentiate, careful examination usually allows the physician to identify the epididymis and the testicle proper as ovoid and not deformed. Torsion was described and is best identified by the methods alluded to in Questions 5 and 6. However, in torsion, despite confounding edema, one should appreciate that the testicle itself is the source of tenderness and that the epididymis is normal in size and not tender. Orchitis manifests tenderness of the testicle and, in most cases, enlargement but no change in the basic shape of the organ. The signs of ischemia and lack of evidence of obstructed arterial flow usually allow torsion to be ruled out. Testicular cancer manifests an