Challenger Medical Education Blog

A 2-year old boy presents to the ED with left hemiscrotal swelling

Written by Med-Challenger | Jan 24, 2025 3:07:42 PM

A 2 yo boy presents to the ED with left hemiscrotal swelling. The parents have noticed intermittent mild swelling over the past several weeks, but tonight in the bath, they noticed that the swelling was significantly larger. The patient seems a little uncomfortable to the parents, but he has not had any vomiting, fever, or difficulty urinating. His exam is notable for tense left hemiscrotal swelling. Cremasteric reflexes are intact, and the testicular lie is vertical, but it is difficult to assess the size of the testis due to the swelling. There is no overlying discoloration. An ultrasound is obtained with an image shown below.

Photo courtesy of Kathleen Kieran, MD

What is the most appropriate next step?

  • Arrange for a testicular biopsy as an outpatient
  • Follow up with a surgeon for elective repair
  • No further work-up or management is indicated
  • Obtain a urinalysis with culture

 

This question appears in Med-Challenger Pediatric Emergency Medicine 3rd Edition Exam Review with CME

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