Choice A. Abdominal and pelvic CT scan is indicated to evaluate significant trauma (eg, gunshot wounds) or for Fournier gangrene, which causes severe scrotal pain and edema but is typically associated with fever, erythema, and crepitus on examination.
Explanation
Educational objective: Testicular torsion can present with acute testicular pain and swelling after mild trauma. The diagnosis may be made clinically; however, in patients in whom the diagnosis is unclear, a Doppler ultrasound of the scrotum can confirm the diagnosis and exclude other etiologies.
Choice C.Torsion of the appendix testis (an appendage of tissue located on the upper testis) also causes acute-onset testicular pain, but examination often demonstrates a localized, tender mass on the testis, which may have a blue discoloration. It can be distinguished from testicular torsion with Doppler ultrasound demonstrating normal or increased blood flow to the affected testis. Management is supportive and includes pain management and scrotal elevation.
Choice D. Torsion of the appendix testis (an appendage of tissue located on the upper testis) also causes acute-onset testicular pain, but examination often demonstrates a localized, tender mass on the testis, which may have a blue discoloration. It can be distinguished from testicular torsion with Doppler ultrasound demonstrating normal or increased blood flow to the affected testis. Management is supportive and includes pain management and scrotal elevation.
Choice E. Surgical evacuation of a hematoma can be considered in patients with evidence of a rapidly expanding testicular hematoma that may cause compartment syndrome. However, testicular hematomas are visible on ultrasound and typically occur after blunt force trauma. This patient's mild ecchymosis after minimal trauma makes a rapidly expanding hematoma unlikely.
