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Image of the Month—Quiz Case FREE

Bonnie Sun, MD; Ashkan Moazzez, MD; Rodney J. Mason, MD
[+] Author Affiliations

Author Affiliations:Department of Surgery, University of Southern California Keck School of Medicine, Los Angeles.


Section Editor: E. Bredenberg Carl, MD


Arch Surg. 2009;144(11):1085. doi:10.1001/archsurg.2009.186-a.
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An 84-year-old Latino man presented to the emergency department with a recent 3-day history of pain over a preexisting left inguinal hernia, which had been present for the past 5 years. The patient had been obstipated for 3 days but denied any other obstructive symptoms. On examination, his vital signs were stable and he had a soft, nondistended, nontender abdomen. There was an irreducible left inguinal bulge and a 15-cm mass in his left scrotum, both of which were tender to palpation. There were no overlying skin changes. Laboratory studies revealed leukocytosis (white blood cell count, 13 800/μL, with 85% neutrophils). A computed tomography scan was performed (Figure 1and Figure 2).

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Figure 1.

Computed tomography scan of the left scrotum shows a large structure with an air-fluid level.

Graphic Jump Location

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Figure 2.

Computed tomography scan of the left scrotum using lung windows to illustrate the air-filled compartments.

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WHAT IS THE DIAGNOSIS?

A. Scrotal abscess

B. Testicular torsion

C. Amyand hernia

D. Perforated diverticulitis

Figures

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Figure 1.

Computed tomography scan of the left scrotum shows a large structure with an air-fluid level.

Graphic Jump Location
Place holder to copy figure label and caption
Figure 2.

Computed tomography scan of the left scrotum using lung windows to illustrate the air-filled compartments.

Graphic Jump Location

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The American Medical Association is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians. The AMA designates this journal-based CME activity for a maximum of 1 AMA PRA Category 1 CreditTM per course. Physicians should claim only the credit commensurate with the extent of their participation in the activity. Physicians who complete the CME course and score at least 80% correct on the quiz are eligible for AMA PRA Category 1 CreditTM.
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