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Image of the Month—Quiz Case
Bonnie Sun, MD;
Ashkan Moazzez, MD;
Rodney J. Mason, MD
Arch Surg. 2009;144(11):1085.
INTRODUCTION
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 1 and Figure 2).
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Figure 1. Computed tomography scan of the left scrotum shows a large structure with an air-fluid level.
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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
Answer
Author Affiliations: Department of Surgery, University of Southern California Keck School of Medicine, Los Angeles.
SECTION EDITOR: CARL E. BREDENBERG, MD
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Image of the Month—Diagnosis
Arch Surg. 2009;144(11):1086.
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