SonoCase: 22yr old male blunt trauma to scrotum – by Dr. Cannis et al. in @westjem #FOAMed

March 2013 was a great month for ultrasound case reports and publications – especially in Western Journal of Emergency Medicine! Once again, the team from USC highlight a case where ultrasound is used at its best. As they state: “its greatest asset lies in the ability to rapidly make the diagnosis of a time-sensitive medical condition, enabling the [emergency phsyician] to mobilize resources and expedite treatment, which might otherwise be delayed. The use of [emergency] US for the evaluation of scrotal injury from blunt trauma exemplifies this point.” Isn’t it great when you include ultrasound in your examination of a patient who you will call a specialist for anyway, but to also describe the injury to them in detail, including whether there is hematoma, blood flow, or other findings – and expedite specialty care? YES! They do an excellent job in describing scrotal anatomy, the risks of missing injuries, and the findings of the case while reviewing scrotal ultrasound and the literature around it as well. This is worth the time to read it!

The case: “22-year-old male with no significant past medical history presented to the Emergency department approximately 3 hours after he was in an altercation, during which he sustained multiple blows to the head, stomach, and genital area with a large flashlight. His primary complaint was of severe testicular pain.

Physical examination revealed a calm, well-developed male in mild distress due to pain. Vital signs included a blood pressure 132/85 mmHg, heart rate of 90 beats per minute, respiratory rate 16 breaths per minute, and temperature 98.9°F. On examination of the genitals, the penis was normal. His scrotum was enlarged to approximately the size of a grapefruit, and the overlying skin was erythematous. The scrotal area was exquisitely tender to palpation, making it impossible to reliably identify or examine either testis, despite the use of parenteral opioid analgesia. A urinalysis was obtained, which was normal and notably negative for blood.” The ultrasound study showed:

Read on more, as there are more videos, and a great description of scrotal trauma and injuries with an evidence based review.

 

A great pictorial review of testicular ultrasound and pathology, go here.

SonoCase: Pediatric lower abdominal bulge? What the…?

You know, working in the pediatric ER is always a joy since most children are going to do well (and most parents are worry warts – but who am I kidding, I would be too!). But sometimes I get a case that surprises me – and this is one of them. Of course, in hindsight, it makes sense, but still interesting given the way the kid presented: 4 year old boy, with a history of “retractable bulges a few years ago” comes to the ER after his mom noticed that he woke up that morning (4 hours prior to arrival) walking funny. She took down his very cute Star Wars pajama pants and saw this: