Case 358 Medical History A 26-year-old male patient, with neither comorbidities nor use of medicines, seeks for urgency health service complaining of severe left inguinal pain radiating to the ipsilateral testicular region, which had started approximately one hour before. Physical examination demonstrated that the left testicle was painful, elevated and horizontalized over its longest axis. Prehn’s sign was negative and left cremasteric reflex was absent. Clinical diagnosis of testicular torsion was made and manual detorsion was attempted, with partial relief of pain. Scrotal scintigraphy was requested (images 1 and 2). Scrotal scintigraphy: dynamic imaging acquired immediately after the intravenous administration of the radiopharmaceutical (99mTc-PYP), corresponding to the pelvis and superior portion of the patient’s thighs, who is placed supine in frog-leg position. The penis is elevated and positioned over the abdomen, demonstrating blood flow through the aorta, iliac arteries and scrotum.Scrotal scintigraphy: static planar imaging of pelvis, upper thighs and scrotum in blood pool phase, sequentially acquired after flow phase. QuestionConsidering the clinical history and scintigraphy imaging findings, what is the most appropriate approach? a) Further investigation with complementary exams. b) Elective procedure of scrotal fixation. c) Hospital discharge. d) Immediate bilateral orchiopexy. Test Question (EBSERH – Urologist – 2015) You are called for the evaluation of an adolescent with acute onset pain and swelling in the right testicle, without a history of genital trauma.Question:Regarding the diagnosis, mark the correct alternative: a) Testicular ultrasound, which is essential for diagnosis and management. b) You should think about testicular cancer, as the patient is an adolescent and in this age group this type of tumor is more frequent. c) Should perform clinical treatment thinking about acute scrotum. d) The right testicular torsion should be considered and surgical exploration should be immediate, regardless of the time of fasting. Time is Up! Time's up
