16686548
General weakness, tea-colored urine, for 2 weeks
f/u at 揚德健康診所, Viread was prescribed
Nausea, poor appetite today
Fever-, abdominal pain-, diarrhea-

Hx: HBV
NKDA

1. HBV acute flare-up


1

CT in Differentiating Complicated From Uncomplicated Appendicitis: Presence of Any of 10 CT Features Versus Radiologists' Gestalt Assessment.

# Evaluation of acute scrotal pain in adults
6/19 Kfsyscc PGY Case-based-discussion

## Antatomy of Scrotum
## Evaluation of a SCrotal Mass

## Overview of the Causes of Scrotal Masses

## Reference:
* [Evaluation of scrotal masses](https://www.aafp.org/afp/2014/0501/p723.html)
* [Testicular Torsion](https://www.aafp.org/afp/2006/1115/p1739.html)
* [EPIDIDYMITIS-THE OPTIMAL UROLOGIC EVALUATION MANAGEMENT APPROACH IN THE URGENT CARE SETTING](https://www.jucm.com/epididymitis-optimal-urologic-evaluation-management-approach-urgent-care-setting/)
* [UpTodate](https://www.uptodate.com/contents/evaluation-of-acute-scrotal-pain-in-adults)

---
## Case 1

:::info
主訴: left scrotal pain for 2 days

66yM, progressive(慢慢發生) left scrotal pain for 2 days, no pain, no fever or chills, no abdominal pain, no previous hernia history
過去史/葯物史: HTN on regular medication, no surgical history
過敏史: NKDA
:::


---
## Case 2
:::success
主訴: Scrotal swelling for 1 week
現病史:
63M, HF, CKD, scrotal swelling (跟梨子一樣大) for 1 weeks with local heat and pain, decreased urine output, abdominal dullness, dyspnea(講話就喘).
no fever, no chest tightness
:::

1. Bilateral hydrocele and scrotal soft tissue edema with impending infection, s/p bilateral hydrocelectomy and incision of drainage of soft tissue on 2019/02/26
2. Severe mitral and tricuspid regurgitation with congestive heart failure s/p mitral valvuloplasty and annuloplasty, tricuspid annuloplasty 
3. Dilated cardiomyopathy with acute decompensated heart failure and respiratory failure s/p endotracheal intubation and mechanical ventilation 
4. Pulseless ventricular tachycardia s/p DC shock and cardiopulmonary resuscitation 
5. Atrial fibrillation s/p left atrial maze operation 
6. Hypertension 
7. Liver cirrhosis with ascites 
過敏史: unremarkable

意識: alert
頭頸部:no pale conjunctivae; no icteric sclera
胸部(心、肺): bilateral basal rales; IRHB, murmur noted
腹部:10cm*8cm, firm, scrotum with skin erythematous and local heat, no skin ulcer, no dishcarge, abdominal distended, hypoactive BS; dull on percaustion, no tenderness or peritoneal signs
四肢: bilateral leg edema and statis dermatitis, no ulcer, freely movable, warm

#### Dx:
1. Bilateral hydrocele and scrotal soft tissue edema with impending infection
2. Dypnsea


---
## Case 3
:::warning
主訴: right testis pain
現病史:
right testis pain with swelling for 1-2 days
with radiation to right inguinal area
fever noticed at ER
no vomiting / no diarrhea / no flank pain
過去史: HTN
:::

:::success
echo : swelling of epididymis. no poor perfusion of testis, minimal fluid at scrotum
:::

:::info
Chlamydia trachomatis and Neisseria gonorrhoeae are the most common organisms responsible for bacterial epididymitis in males younger than 35 years.
:::