Twists and turns: Testicular torsion

Case presentation

A 15-year-old male presents with left scrotal pain and swelling for the past 5 hours. He states that he was jumping on a trampoline just prior to presentation and afterward, he experienced his symptoms. He denies genital trauma. He has not had fever, back pain, dysuria, hematuria, penile discharge, abdominal pain, or vomiting. He denies being sexually active.

Physical examination reveals a well-appearing pleasant adolescent in some discomfort. He is afebrile but he is mildly tachycardic with a heart rate of 110 beats per minute; his respiratory rate is 16 breaths per minute; his blood pressure is 125/65 mm Hg. He has a nontender abdominal examination without rebound, guarding, or masses. His genital examination demonstrates a Tanner IV male, without obvious erythema or masses. There are no signs of trauma. He has tenderness to the left epididymis and to the left scrotum in general. The testicles feel normal but he has pain with examination of the left side and the left testicle appears to lie slightly higher than the right. There is mild left scrotal swelling. He is circumcised. There is no discharge from the penis. There are no lesions.

Imaging considerations