Testicular torsion: acute testicular pain in a teenage boy
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A 14 year old boy presented to the emergency department with a three hour history of left sided testicular pain. The pain had woken him and had worsened over time. He said that ibuprofen helped to alleviate the pain slightly. He described the pain as severe, aching in character, and non-radiating. He denied experiencing other symptoms, prior episodes of testicular discomfort, or recent trauma. He was otherwise healthy except for anxiety, for which he took a regular anxiolytic. On physical examination the left testis and epididymis were enlarged and tender, with a normal axis. Also, the cremasteric reflex was apparent on the right side but could not be elicited on the left. He subsequently had a scrotal ultrasound scan.
(2) Fig 1 is a transverse, colour Doppler image of the testes, showing a normal right testis, with good vascular flow, compared with an enlarged, avascular left testis. This is highly