COTW 1/20: 34 year old male with testicular pain

A 34 year old male presented to the ED with 2 days of atraumatic left side testicular pain. Patient denies history of weight loss, STD, trauma, skin changes or urinary symptoms. Point of care ultrasound was performed:

Point of care ultrasound showed multiple intra-testicular located cysts with internal echoes. These poorly defined cystic structures were concerning for malignancy. When obtaining testicular ultrasound, there are characteristics that raise concern for malignancy:

1. Increase vascularity

2. Heterogeneous hypo-echoic cysts/masses

Reassuring characteristics include:

1. Simple homogeneous cysts

2. Anechoic structures with defined borders

Point of care ultrasound shortened patient’s length of stay and provided ED physician valued information for the surgery team. Patient underwent total orchiectomy which revealed testicular seminoma. Patient is currently undergoing treatment.