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What’s the Diagnosis?

Case of the Month

The New Physician October 2014

One-day old newborn with mass

By John T. Barnard, Morris L. Jessop, Osama Al-Omar and Stanley Zaslau. Division of Urology, West Virginia University

The case below is followed by a choice of diagnoses. Select the answer choice that best describes this patient’s condition. 

Figure 1A 1-day-old male born to a 27-year-old G2P2 at 39 6/7 weeks via cesarean section for polyhydramnios is transferred from an outside facility for evaluation of a scrotal mass because pediatric subspecialty services are not available at the hospital where the newborn was delivered. The newborn is otherwise comfortable at the time of transfer. Records indicate that the mother received adequate prenatal care with all labs returning unremarkable throughout the pregnancy. She had a screening ultrasound at 18 weeks gestation that showed a normal fetus with no evidence of structural abnormalities. The fetus appeared to have male genitalia. The mother is a non-smoker and non-drinker who is employed as an administrative assistant. The father is 29 years old and has a medical history of hypertension, Type II diabetes and obesity. APGAR scores at delivery were 8 and 9. Vital signs on initial evaluation reveal a temperature of 98.2˚ F (36.8˚ C), heart rate of 174 beats/minute, respirations of 57/minute, and oxygen saturation of 100% on room air. Physical examination on presentation reveals a large-for-gestational-age infant (9 lbs. 10 oz.) who is vigorous, healthy appearing, and demonstrating a strong cry. The cardiac examination revealed a regular rate and rhythm. Respiratory examination reveals no evidence of wheezes, rhonchi or rales. The abdominal examination reveals no evidence of guarding or rebound tenderness. The umbilical cord stump is present and undergoing expected degeneration. Genitourinary exam reveals a normal, uncircumcised penis with bilaterally descended testes. The left hemiscrotum demonstrates a light purple hue on inspection. Palpation of the scrotal contents reveals a left testis that is distinctly enlarged and firm relative to the contralateral testis; there is no appreciable change in the patient’s behavior on deep palpation. Transillumination of the scrotum reveals a homogenous glow with well-demarcated testicular borders bilaterally. The remainder of the physical examination is unremarkable. Scrotal ultrasound was performed on presentation; the findings on transverse view are depicted above (Figure 1). 

What is the most likely diagnosis? 

A. Intravaginal testicular torsion 

B. Hematocele secondary to birth trauma 

C. Extravaginal testicular torsion 

D. Incarcerated inguinal hernia

Go to the answer page


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