Hepatic Artery Rupture in a Young Man with Abdominal Pain and a Testicular Mass.

BACKGROUND: Male patients presenting to the emergency department (ED) with abdominal pain accompanied by a testicular mass should be evaluated for the presence of hernia, epididymitis, orchitis, and testicular torsion. When a patient presents with an asymptomatic testicular nodule or mass, the emergency physician should consider testicular carcinoma, a diagnosis that typically warrants no more than prompt urologic outpatient referral.

CASE REPORT: We present a case involving a young male whose presenting complaint was abdominal pain. Despite his reluctance to initially discuss any genitourinary (GU) complaints, careful questioning and thorough examination revealed a large left testicular mass. Despite having a benign abdomen, the patient experienced a rapid clinical deterioration in the ED after a previously undiagnosed metastatic lesion to his liver eroded into his hepatic artery. WHY SHOULD AN EMERGENCY PHYSICIAN BE AWARE OF THIS?: This case highlights the importance of performing a GU examination in all patients presenting with abdominal pain and discusses a rare presentation of a relatively common male condition. We also discuss the prioritization of emergent interventions and diagnostic studies specific to this case.