An Unusual Case of Acute Scrotal Pain

Abstract

Patients frequently present to the emergency department with complaints of scrotal or testicular pain. Generally, there is an algorithmic approach to workup, which includes assessment for torsion, infection, or vascular causes, and musculoskeletal causes of pain are also sometimes considered. Spinal cord pathology, however, is less often explored as a cause of testicular pain. Here, we present a case of a 45-year-old man with end-stage renal disease and hypertension who presented with acute testicular pain. After a comprehensive workup, however, the source of pain was not initially found. Progression of the patient's symptoms led to the diagnosis of spontaneous spinal subdural hematoma. This atypical presentation of a rare diagnosis is also interesting due to the patient's concomitant diagnosis of an otherwise asymptomatic COVID-19 infection. While our case represents an atypical combination of clinical features, it also illustrates the importance of continued vigilance and ongoing workup when patients present with severe pain and unclear causes of their symptoms.

Keywords: covid-19; emergency department; focal neurologic deficit; groin pain; idiopathic spinal subdural hematoma; scrotal pain; spontaneous spinal hematoma; testicular pain.

Figure 1. Chest radiograph showing cardiomegaly with pulmonary edema

Figure 2. Testicular ultrasound showing homogeneous texture and normal Doppler flow

Figure 3. Sagittal lumbar spine MRI T2 image showing multilobulated, hyperintense mass associated at the level of L1-L3 measuring approximately 1.1 cm AP by 0.9 cm by 6.2 cm