Epididymitis and testicular torsion

Epididymitis and testicular torsion are both causes of scrotal pain. Testicular torsion requires prompt recognition and surgical intervention to avoid testicular damage. Epididymitis is easily managed with antibiotics. Differentiation between the two disorders is important. Review the case and answer the questions.

Case 1

A 15-year-old presents to the emergency department complaining of sudden onset of right-sided scrotal and groin pain. He states the pain is constant and extreme. He said it started about 2 hours ago during basketball practice at school, but he denies any trauma to the scrotum. He is worried that he has a sexually transmitted infection as he just started having sexual intercourse with his girlfriend and he did not use condoms. He says he feels nauseated and thinks he is going to vomit. He said he noticed this same pain once before, but it went away within a few seconds and he did not tell anyone.

Physical examination reveals a healthy-appearing adolescent who is anxious and grimacing. The patient has edema and erythema of his right scrotum. His scrotum is tender, and the patient only tolerated superficial palpation. Vital signs: temperature 98.9°F; pulse 100 beats per minute; respirations 20 per minute; blood pressure 120/70 mmHg.

Answer the following questions or provide responses based on this case.

1. The most likely diagnosis based on his history is:

Epididymitis
Testicular torsion

2. Erythema and edema of the scrotum are only present with epididymitis.  True or False

3. Which clinical manifestations are consistent with epididymitis, and which are consistent with testicular torsion?

Positive Prehn sign
Negative cremasteric reflex
Testis elevated on affected side
Fever

4. Which diagnostic test is most appropriate to confirm the suspected diagnosis?

A complete blood count with differential
An MRI of the scrotum
A Doppler ultrasound of the scrotum
A urine culture and sensitivity

5. Discuss the treatment plans for testicular torsion and epididymitis.