Saturday, December 14, 2024

game of balls

 

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…

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