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Case Analysis Tool Worksheet

Student’s Name: Case ID: Family Medicine – Case 27

I. Epidemiology/Patient Profile:
Andrew is a 17-year-old healthy male presents with severe acute right sided groin pain that
radiates to the right scrotum x 4 hours. Previously similar episode – resolved spontaneously.
Patient reports nausea but denies diarrhea and urinary symptoms.

II. Prioritized Cues from History and PE:

Tier 1 Tier 2 Tier 3

Severe right sided groin pain No penile discharge, inguinal Previously similar episode –
with radiation to right lymphadenopathy, or hernias resolved spontaneously
scrotum
Acute sunset of 4 hours ago No palpable mass Appendectomy at age 12
Swollen and erythematous Sexually active Viral gastroenteritis at age 1
right scrotum
Right testicle tender, swollen Reports nausea URI at age 5
Absent blue dot sign, no Denies diarrhea
transillumination of scrotum
Negative Prehn sign
Cremasteric reflex absent on
the right

III. Problem Statement:

Andrew is a 17-year-old healthy male who is sexually active that is presenting with severe
right sided groin pain that radiates to the right scrotum x 4 hours. Patient reports nausea but
denies vomiting, diarrhea, fevers, and urinary symptoms. A swollen erythematous right
scrotum with a tender right scrotum is noted. No masses are noted in either testicle. There is
no transillumination of the scrotum, absent blue dot sign, absent cremasteric reflex, and a
negative Prehn sign. The patient reports a similar episode that resolved spontaneously 6-9
months ago.

IV. Differential Diagnosis:

Leading Testicular Torsion

Diagnosis:
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History Finding(s) Physical Exam Finding(s)

Severe right sided groin pain with radiation to Cremasteric reflex absent on the right
right scrotum
Acute sunset of 4 hours ago Negative Prehn sign
Tenderness is not localized to the upper pole Absent blue dot sign, no transillumination of
of testis scrotum
Absence of systemic signs of infection Right testicle tender, swollen
Absence of urinary symptoms Swollen and erythematous right scrotum

Alternative Trauma
Dx:

History Finding(s) Physical Exam Finding(s)

Acute pain to scrotum Swollen and erythematous right scrotum
Right testicle tender and swollen

Alternative Epididymitis
Dx:

History Finding(s) Physical Exam Finding(s)

Sudden severe scrotal pain Severe swelling on the involved side
One side effected Scrotum tender on palpation and edematous
Patient is sexually active

V. Explanation of Diagnostic Plan and Treatment Plan in prioritized order:

Diagnostic Plan Rationale

Color Doppler Ultrasound
Radionuclide Scintigraphy
To evaluate the intratesticular blood flow
because it is usually decreased or absent if
testicular torsion is present (Nishizawa et al.,
2021)
To visualize testicular blood flow. Since the
patient with testicular torsion possibly has a
decreased radiotracer in the ischemic testis,
resulting in photopenic lesion (Laher et al.,
2020)

Treatment Plan Rationale

Surgical Intervention STAT Surgery is required to restore blood flow to
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the affected testicle to prevent infarction or

Referral to Urology specialist
Follow up with PCP in 1 week
Patient Education
death of testis (Lewis et al., 2020)
To ensure that there are no complications
post-op and to perform a thorough evaluation
of the condition.
To ensure that there are no complications
post-op.
Educate the patient and parent to call the
healthcare provider if patient is experiencing
pain or swelling in the testicle or scrotum. If
symptoms return, it's a medical emergency
and patient should be taken to hospital.
Educate the patient to notify the provider if
fever of 100.4ºF (38°C) or above, nausea or
vomiting that won't go away, abdominal pain,
urination difficulties, and if testicle shrinks,
indicating condition return and infection.

I have adhered to the honor

system:
Student’s Signature

Date:
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Reference

Laher, A., Ragavan, S., Mehta, P., & Ahmed, A. (2020). Testicular Torsion in the Emergency
Room: A Review of Detection and Management Strategies. Open Access Emergency
Medicine, 12, 237-246. http://dx.doi.org/10.2147/OAEM.S236767
Lewis, S., Hopkins, L., Evans, T., Lewis, W., & Harries, R. (2020). Testicular torsion treatment:
the horns of a dilemma? Annals of the Royal College of Surgeons of England, 102(1), 49-
53. http://dx.doi.org/10.1308/rcsann.2019.0150
Nishizawa, T., Kobayashi, D., Uematsu, H., & Taguchi, T. (2021). Ultrasonographic ‘whirlpool
sign’ in testicular torsion. BMJ Case Reports, 14(5)http://dx.doi.org/10.1136/bcr-2021
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