24 Yo Male Presents With Moving Testicular Pain

24 yo male presents with moving testicular pain.
Pt reports testicular torsion at HFM at 3/18 s/p

detorsion. Pt reports that pain presisted but he was reassured that blood flow is still present so does not
need removing of testicle. Pt reports 2 weeks of worsening flank pain and hemoptysis. Pt reports pain is
sharp stabbing and does notradiate. Hemptysis scant about 2 table spoon. Reports 15 to 16 lb wt loss
PMH:
Testicular torsion
Hyaline membrane disease
Alcohol abuse
Depression
Anxiety
PSH: testicular torsion
SH: ppd since he was 14 – dc with nicotine patch, .5 gallon per day of beer?, THC tried
Lives with family at home
Parents: mother cervical cancer and DM2, paternal grandpa had stomach cancer
Lives with mom at home worked at mcdonalds
+ fever chills weight loss hemoptysis cough
TTA at T12 – severity 2/3, correlate with viscerosomatic reflex
- Neg for Pruritis rash chest pain chest pressure dyspnea paralysis parestheia hematuria dysuria
Physical Exam:
NAD, AAO x 3 PERRLA
normocephalic atrumatic
CTAB w/out wrr
RRR with no M s1 s2 auscultated
Soft, ND, tender to palpation on left lower quadrant and left flank
2/4 radial pulse b/l , Warm dry no C/C/E
Cn 2 to 12 intact
98.6 97 percent ra 18 106/66 83 ht 68inch wt
CTPE
Findings:
No evidence of axillary or thoracic lymphadenopathy.
Heart size is within normal limits. No pericardial effusion.
No evidence of thoracic aortic aneurysm.
No filling defects seen within the pulmonary arteries.
No pleural effusions.
Multiple bilateral pulmonary nodules noted. The largest nodule within the
right lung measures up to 2.6 cm at the right lung base. The largest nodule
within the left lung measures up to 2.0 cm at the left lung base. Of note,
some of the pulmonary nodules demonstrate surrounding ground-glass opacities,
which may relate to surrounding alveolar hemorrhage.
No pneumothorax.
Bilateral gynecomastia noted.
Please refer to CT abdomen/pelvis from same day for complete description of

the upper abdomen.
No acute osseous abnormality seen. No evidence of osseous destruction.
IMPRESSION:
1. No evidence of pulmonary embolism.
2. Innumerable bilateral pulmonary nodules, which is concerning for
metastatic disease.
US Testicle b/l
Findings:
The right testicle measures 4.6 x 2.8 x 3.3 cm and demonstrates normal
homogeneous echotexture.
The left testicle measures 7.6 x 6.2 x 7.4 cm. Of note, the majority of the
left testicle is replaced by a complex mass-like lesion measuring
approximately 6.6 x 5.4 x 5.8 cm.
The testicles demonstrate normal color Doppler flow with spectral waveforms.
The right epididymis is unremarkable. The left epididymis was not visualized.
No evidence of hydroceles or varicoceles.
Impression:
1. The majority of the left testicle is replaced by a complex mass-like

lesion, measuring up to 6.6 cm. An infectious/inflammatory process along with
a neoplastic process is difficult to exclude. Correlation with prior exams is
recommended if available.
2. No evidence of testicular torsion.
3. The right testicle is unremarkable.
CT abd pelvis
Findings:
Please refer to CT PE protocol from same day for evaluation of the lower
thorax.
The liver, spleen, adrenal glands, and pancreas are unremarkable.

Gallbladder is present. No evidence of intra or extrahepatic biliary ductal
dilatation.
Conglomerate heterogeneous/hypodense lymph nodes noted within the retrocrural

region and retroperitoneum. The largest conglomerate lymph node within the
left. Is within the left periaortic region and measures approximately 5.1 x
5.4 cm. The largest retrocrural lymph node is within the left retrocrural
region and measures 2.2 x 2.5 cm.
The conglomerate retroperitoneal lymph nodes within the left periaortic

region likely relate to obstruction of the proximal left ureter with moderate
left-sided hydronephrosis. Delayed enhancement of the left kidney compared
to the right noted. No evidence of right hydronephrosis.
No evidence of bowel obstruction.
Bladder is nondistended.
Please note that evaluation of the inferior vena cava is limited secondary to
mixing of contrast.
No evidence of ascites.
No evidence of free air.
No acute osseous abnormality seen. No evidence of osseous destruction.
IMPRESSION:
1. Conglomerate heterogeneous lymphadenopathy within the retroperitoneum and

retrocrural regions. Findings most consistent with metastatic disease,
especially given mass-like lesions seen within the left testicle on
ultrasound study from same day.
2. Moderate left-sided hydronephrosis likely secondary to extrinsic
obstruction of the ureter the conglomerate retroperitoneal lymphadenopathy.
Of note, there is delayed enhancement of the left kidney compared to the
right also seen.
3. Please refer to CT PE protocol from same day for complete description of
the thorax.
CT brain
FINDINGS:
No mass effect or midline shift. No intracranial hemorrhage or extra-axial
fluid collection. Ventricles have a normal morphology, and are without
effacement. No definitive CT evidence for acute, territorial infarction.
No pathologic enhancement is identified.
No depressed skull fractures. Orbital contents are symmetric. Visualized

portions the of the paranasal sinuses are within normal limits. Mastoid air
cells are well-aerated.
IMPRESSION:
1. No acute intracranial process.

2. No pathological enhancement.
MT CLEMENS REGIONAL MEDICAL CENTER 38034 JOHANNES DR CLINTON TOWNSHIP, MI 48038
Printed By: SHAH, NISCHAY at 04:54 PM on 2018 Sep 07
Laboratory Results
by Collected Date
Visit ID: 56802766 Name: CANNON, BRANDON
Med Rec #: 4502149 Sex: M
Admitted: 09/03/2018 15:15 Birth Date: 1/4/1994
Location: FOUR WEST - 0469-1

(This is not a chartable copy.)
09/0 09/0 09/0 09/0 09/0 09/0 09/0 09/0 09/0 09/0
09/03 09/03
09/06/1 4/18 4/18 4/18 3/18 3/18 3/18 3/18 3/18 3/18 3/18
/18 /18
8 06:00 13:16 06:00 06:00 15:18 15:18 14:11 13:09 12:59 12:59 12:59
15:18 14:11
#0056 #004 #002 #002 #002 #002 #001 #000 #000 #000 #000
#0030 #0014
8 6 5 9 8 2 3 4 2 1
2778.
Alpha 2
AlphaFeto
FetoProt H(0.0 3334.
Protein,
ein- -7.9 0H
Tumor
Tumor ng/mL
)
BASIC
121
METABO 115
Glucose H(70-110 88
LIC H
mg/dL)
PANEL
14.00(7.
BUN 00-20.00 12.00 12.00
mg/dL)
0.920(0.
550-
Creatinine 1.140 1.110
1.300
mg/dL)
134(60-
eGFR
200
African 104 107
mL/min/1
American
.73m2)
Laboratory Results
by Collected Date

116(60-
eGFR Non
200
African 90 92
mL/min/1
American
.73m2)
15.22(12
BUN/Crea 10.53 10.81
.00-20.00
t Ratio L L
Ratio)
138.00(1
35.00- 136.0 138.0
Sodium
147.00 0 0
mmol/L)
5.10(3.5
Potassium 0-5.30 4.20 4.00
mmol/L)
104.00(9
6.00- 100.0 102.0
Chloride
112.00 0 0
mmol/L)
26.00(21
Carbon
.00-32.00 26.00 29.00
Dioxide
mmol/L)
8.00(6.0
Anion Gap 0-14.00 10.00 7.00
mmol/L)
8.40(8.2
Calcium 0-10.60 8.90 8.90
mg/dL)
10.16
H(4.5
0-
CBC w WBC 10.14
10.00
Auto Diff Count H
X
10*3/
uL)
Laboratory Results
by Collected Date

4.50(
4.26-
RBC 5.62
4.62
Count X
10*6/
uL)
13.8(
Hemoglob 13.0-
14.5
in 17.0
g/dL)
40.5(
Hematocri 39.1-
41.7
t 50.1
%)
90.0(
80.0-
MCV 90.3
97.0
fL)
30.7(
27.1-
MCH 31.4
33.9
pg)
34.1(
33.2-
MCHC 34.8
35.4
g/dL)
12.1(
11.5-
RDW 12.1
14.5
%)
213(1
40-
Platelet
440 X 217
Count
10*3/
uL)
Laboratory Results
by Collected Date

10.9(
9.5-
MPV 10.6
12.2
fL)
Neuts,
76.2(
Automate 71.2
%)
d
Lymphs,
11.6(
Automate 17.3
%)
d
Monos,
10.3(
Automate 9.3
%)
d
EOS,
1.3(
Automate 1.6
%)
d
Basos
0.2(
Automate 0.3
%)
d
7.74
H(1.8
ABS 0-
7.23
Neutrophi 6.70
H
ls X
10*3/
uL)
1.18(
0.80-
ABS
3.10
Lymphocy 1.75
X
tes
10*3/
uL)
1.05 0.94
ABS
H(0.2 H
Monocyte
0-
Laboratory Results
by Collected Date

s 0.80
X
10*3/
uL)
0.13(
0.00-
ABS
0.50
Eosinophil 0.16
X
s
10*3/
uL)
0.02(
0.00-
ABS 0.20
0.03
Basophils X
10*3/
uL)
Immature
0.4(0.
Grans,
0-0.6 0.3
Automate
%)
d
0.04(
0.00-
Immature
0.04
Grans 0.03
X
Absolute
10*3/
uL)
Compreh
121
ensive 115
Glucose H(70-110 88
Metaboli H
mg/dL)
cP
0.70(0.2
Bilirubin
0-1.00 0.80
Total
mg/dL)
BUN 14.00(7. 12.00 12.00

00-20.00
Laboratory Results
by Collected Date

mg/dL)
0.80(
0.20-
Bilirubin
1.00
Total
mg/dL
)
0.920(0.
550-
Creatinine 1.140 1.110
1.300
mg/dL)
Alkaline 148
150
Phosphat H(50-136
H
ase U/L)
134(60-
eGFR
200
African 104 107
mL/min/1
American
.73m2)
150
Alkaline
H(50-
Phosphat
136
ase
U/L)
ALT 18(13-61
13
(SGPT) U/L)
116(60-
eGFR Non
200
African 90 92
mL/min/1
American
.73m2)
13(13
ALT
-61
(SGPT)
U/L)
20.00(15
AST
.00-37.00 17.00
(SGOT)
U/L)
Laboratory Results
by Collected Date

2.90
L(3.50-
Albumin 3.80
5.20
g/dL)
6.20
Total L(6.40-
7.60
Protein 8.20
g/dL)
3.3(2.0-
Globulin 3.8 H
3.5 g/dL)
AGR (
0.9
Albumin/
L(1.5-2.5 1.0 L
Globulin
g/dL)
Ratio)
15.22(12
BUN/Crea 10.53 10.81
.00-20.00
t Ratio L L
Ratio)
AGR ( 1.0
Albumin/ L(1.5-
Globulin 2.5
Ratio) g/dL)
138.00(1
35.00- 136.0 138.0
Sodium
147.00 0 0
mmol/L)
5.10(3.5
Potassium 0-5.30 4.20 4.00
mmol/L)
104.00(9
6.00- 100.0 102.0
Chloride
112.00 0 0
mmol/L)
26.00(21 26.00 29.00

Carbon
.00-32.00
Laboratory Results
by Collected Date

Dioxide mmol/L)
8.00(6.0
Anion Gap 0-14.00 10.00 7.00
mmol/L)
8.40(8.2
Calcium 0-10.60 8.90 8.90
mg/dL)
0.70(0.2
Bilirubin
0-1.00
Total
mg/dL)
Alkaline 148
Phosphat H(50-136
ase U/L)
ALT 18(13-61
(SGPT) U/L)
20.00(15
AST
.00-37.00
(SGOT)
U/L)
2.90
L(3.50-
Albumin
5.20
g/dL)
6.20
Total L(6.40-
Protein 8.20
g/dL)
3.3(2.0-
Globulin
3.5 g/dL)
AGR (
0.9
Albumin/
L(1.5-2.5
Globulin
g/dL)
Ratio)
Laboratory Results
by Collected Date

HCG >2000
Beta HCG
Blood 00.00
Quantitati
Quantita H(0.00-
ve
tive 4.00)
0.24(
HEPATIC
0.00-
FUNCTI Bilirubin
0.40
ON Direct
mg/dL
PANEL
)
0.70(0.2
Bilirubin
0-1.00 0.80
Total
mg/dL)
0.56(
0.00-
Bilirubin
1.00
Indirect
mg/dL
)
Alkaline 148
150
Phosphat H(50-136
H
ase U/L)
ALT 18(13-61
13
(SGPT) U/L)
20.00(15
AST
.00-37.00 17.00
(SGOT)
U/L)
2.90
L(3.50-
Albumin 3.80
5.20
g/dL)
6.20
Total L(6.40-
7.60
Protein 8.20
g/dL)
Laboratory Results
by Collected Date

3.3(2.0-
Globulin 3.8 H
3.5 g/dL)
AGR (
0.9
Albumin/
L(1.5-2.5 1.0 L
Globulin
g/dL)
Ratio)
0.70(0.2
Bilirubin
0-1.00
Total
mg/dL)
Alkaline 148
Phosphat H(50-136
ase U/L)
ALT 18(13-61
(SGPT) U/L)
20.00(15
AST
.00-37.00
(SGOT)
U/L)
2.90
L(3.50-
Albumin
5.20
g/dL)
6.20
Total L(6.40-
Protein 8.20
g/dL)
3.3(2.0-
Globulin
3.5 g/dL)
AGR (
0.9
Albumin/
L(1.5-2.5
Globulin
g/dL)
Ratio)
Lactic Lactic 0.9(0.

Laboratory Results
by Collected Date

Acid Acid 5-2.0

Venous Venous mmol/
L)
507.0
LDH 0
Lactate
Lactate H(87.
Dehydrog
Dehydro 00-
enase
gen 241.0
0 U/L)
UA
UA 1.029(
Chem
Specific 1.003- 1.028
Routine
Gravity 1.029)
Analysis
5.5(4.5
UA PH 5.5
-7.8)
2.0(0.0
UA
-2.0
Urobilinog 2.0
E.U./DL
en
)
Urinalysi UA 1.029(
s With Specific 1.003- 1.028
Culture I Gravity 1.029)
5.5(4.5
UA PH 5.5
-7.8)
2.0(0.0
UA
-2.0
Urobilinog 2.0
E.U./DL
en
)

24 Yo Male Presents With Moving Testicular Pain

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24 Yo Male Presents With Moving Testicular Pain

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24 yo male presents with moving testicular pain.

Pt reports testicular torsion at HFM at 3/18 s/p

Hyaline membrane disease

PSH: testicular torsion

Lives with family at home

Lives with mom at home worked at mcdonalds

+ fever chills weight loss hemoptysis cough

TTA at T12 – severity 2/3, correlate with viscerosomatic reflex

CTAB w/out wrr

RRR with no M s1 s2 auscultated

2/4 radial pulse b/l , Warm dry no C/C/E

98.6 97 percent ra 18 106/66 83 ht 68inch wt

No evidence of thoracic aortic aneurysm.

No filling defects seen within the pulmonary arteries.

Bilateral gynecomastia noted.

Please refer to CT abdomen/pelvis from same day for complete description of

No acute osseous abnormality seen. No evidence of osseous destruction.

No evidence of hydroceles or varicoceles.

1. The majority of the left testicle is replaced by a complex mass-like

The liver, spleen, adrenal glands, and pancreas are unremarkable.

Conglomerate heterogeneous/hypodense lymph nodes noted within the retrocrural

The conglomerate retroperitoneal lymph nodes within the left periaortic

No evidence of bowel obstruction.

No evidence of free air.

No acute osseous abnormality seen. No evidence of osseous destruction.

1. Conglomerate heterogeneous lymphadenopathy within the retroperitoneum and

No pathologic enhancement is identified.

No depressed skull fractures. Orbital contents are symmetric. Visualized

1. No acute intracranial process.

MT CLEMENS REGIONAL MEDICAL CENTER 38034 JOHANNES DR CLINTON TOWNSHIP, MI 48038

Printed By: SHAH, NISCHAY at 04:54 PM on 2018 Sep 07

Med Rec #: 4502149 Sex: M

Admitted: 09/03/2018 15:15 Birth Date: 1/4/1994

Location: FOUR WEST - 0469-1

Printed By: SHAH, NISCHAY at 04:54 PM on 2018 Sep 07

Med Rec #: 4502149 Sex: M

Admitted: 09/03/2018 15:15 Birth Date: 1/4/1994

Location: FOUR WEST - 0469-1

Printed By: SHAH, NISCHAY at 04:54 PM on 2018 Sep 07

Med Rec #: 4502149 Sex: M

Admitted: 09/03/2018 15:15 Birth Date: 1/4/1994

Location: FOUR WEST - 0469-1

Printed By: SHAH, NISCHAY at 04:54 PM on 2018 Sep 07

Med Rec #: 4502149 Sex: M

Admitted: 09/03/2018 15:15 Birth Date: 1/4/1994

Location: FOUR WEST - 0469-1

Printed By: SHAH, NISCHAY at 04:54 PM on 2018 Sep 07

Med Rec #: 4502149 Sex: M

Admitted: 09/03/2018 15:15 Birth Date: 1/4/1994

Location: FOUR WEST - 0469-1

BUN 14.00(7. 12.00 12.00

Printed By: SHAH, NISCHAY at 04:54 PM on 2018 Sep 07

Med Rec #: 4502149 Sex: M

Admitted: 09/03/2018 15:15 Birth Date: 1/4/1994

Location: FOUR WEST - 0469-1

Printed By: SHAH, NISCHAY at 04:54 PM on 2018 Sep 07

Med Rec #: 4502149 Sex: M

Admitted: 09/03/2018 15:15 Birth Date: 1/4/1994

Location: FOUR WEST - 0469-1

26.00(21 26.00 29.00

Printed By: SHAH, NISCHAY at 04:54 PM on 2018 Sep 07

Med Rec #: 4502149 Sex: M

Admitted: 09/03/2018 15:15 Birth Date: 1/4/1994