A 19-year-old man presents to his primary care physician with a concern about an unusual texture he noticed near his left testicle last week. He noticed this incidentally, and he denies any testicular pain or discomfort, penile discharge, or erectile dysfunction. He hasn’t noticed any changes in urine color and denies any dysuria or flank pain. He does not drink alcohol or smoke cigarettes and eats a healthy diet prescribed by a nutritionist. He admits to occasionally using nicotine pouches. He is sexually active in a monogamous relationship with a woman. He is on the college weightlifting team. Vital signs are within normal limits. On physical examination, there are no masses noted on palpation of the abdomen. The testicles are symmetric in size and shape. Examination of the scrotum in the standing position reveals the presence of a “bag of worms” texture adjacent to the left testicle. This is more noticeable when the patient is asked to perform a Valsalva maneuver. The abnormality does not transilluminate. Testicular size is the same on each side.
Which of the following is the most appropriate next step in the management of this patient?
- A) Cessation of nicotine usage
- B) Computed tomography (CT) scan of the abdomen with contrast
- C) Observation and return precautions
- D) Prostate examination
- E) Referral for surgical embolization
Author(s)
Krishna Tiruchirapalli
Editor(s)
Dr. Ted O'Connell
Last updated
Nov 03, 2024
