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Special Feature
November 16, 2009

Image of the Month—Quiz Case

Author Affiliations

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




Copyright 2009 American Medical Association. All Rights Reserved. Applicable FARS/DFARS Restrictions Apply to Government Use.2009

Arch Surg. 2009;144(11):1085. doi:10.1001/archsurg.2009.186-a

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).

Figure 1.
Image not available

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

Figure 2.
Image not available

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

What Is the Diagnosis?

A. Scrotal abscess

B. Testicular torsion

C. Amyand hernia

D. Perforated diverticulitis