I had always
hated testis pain who presented to ED. The examination includes an ultrasound which
need the physician to touch the sensitive part of the patient. The difficulty is
increased as the ball will be sliding as you glide the probe over the surface. If
the testis is painful the patient would start to resist and the scanning is
more hazardous. Without the power doppler mode, you can only diagnosed testicular
torsion if no definite flow is noted and it would be too late by if you see
this….
Someone had
told me this story months ago; A middle-aged patient was seen few times for
abdominal pain with each consultation separated by 12 hours apart; even though
CT scan was done twice(enhancement and none enhancement) during the visits, he had
still ended with ball removal.
The unless
proven otherwise rule was not applied in the case where the pain was not proper
diagnosed and patient was discharged. The patient was treated as urinary stone where
radiation pain to testis was an acceptable symptom. The key in the case was no
stone was noted by the scan and a negative UFEME was noted.
I had been more
cautious lately and I met a few cases of ball pain lately where I performed ultrasound
without hesitation.
It was an
embarrassed moment for everyone, the physician, the chaperon and the patient. Especially
the chaperon who mostly is the nurse or nursing aide available and most of them
were female.
Frankly said, I hate doing it as flow noted in the ball does not exclude torsion as we had no power doppler mode on our ultrasound and there is a 50% chance a urological consult was unavailable. Our urology consult was supported by two inhouse staff and half of the time the consult was covered by visiting staff who was reluctant to come...
I crossed
my finger on every discharge…
No comments:
Post a Comment