Medical Question of the Day- 23

A 55 year-old man presents to the clinic because today he noticed that his left scrotum has suddenly gotten larger. He has no fever or pain. Examination reveals enlarged left scrotum with no tenderness or any signs of inflammation. There is a worm-like mass posterior to the left testicle. The mass illuminates and is not reducible on compression or when the patient lying down.

What is the best next step in management?

A – Assurance and follow up in 2 weeks

B – Abdominal CT scan

C – MRI of the pelvis

D – Urine culture

E – Refer to surgery for urgent reduction




Answer

This is a case of combined varicocele and hydrocele. Sudden onset and non-reducible mass suggest obstruction of venous drainage. Left testicular vein drains into left renal vein, so, any compression on the left renal vein causes left varicocele. Most cases of renal cell carcinoma in men are accompanied by left varicocele. For this reason, abdominal CT scan is the best next step to evaluate for any masses or tumors.

The correct answer is B







 

7 thoughts on “Medical Question of the Day- 23”

  1. This is suddenly finding new varicocele on the left of the man. With his age and the condition of the mass not reducible on compression or when lying down, we can suspect obstruction of venous drainage. Abdominal CT scan should be the best next step to look for renal cell cancer or other cause of venous obstruction. The patient does not have signs and symptoms of UTI, urine culture is not needed. MRI of pelvis may be needed for additional evaluation later. Referral to surgery is just needed after diagnosis can be confirmed.

    B is the best answer.

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