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JAMA Surgery Clinical Challenge
September 26, 2018

A Not-So-Simple Groin Mass

Author Affiliations
  • 1Harbor-UCLA Medical Center, Torrance, California
JAMA Surg. 2019;154(2):174-175. doi:10.1001/jamasurg.2018.3352

A 55-year-old man with a history of Childs B cirrhosis presented with a 2.5-year history of right groin pain and increased urinary frequency with difficulty voiding. On examination, he had a 5 cm × 3 cm palpable and partially reducible right groin mass that extended into the scrotum. He had a leukocytosis with a leukocyte count of 16 400/μL (to convert to ×109/L, multiply by 0.001), his creatinine level was 1.14 mg/dL (to convert to micromoles per liter, multiply by 88.4), and urinalysis showed leukocyturia with cultures that had positive results for Streptococcus viridians. Axial and sagittal (Figure) computed tomography scans with contrast are shown. A renography using mercaptoacetyltriglycine showed a 34% reduction of right renal function.

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