Patient: A 20-year-old African American man. Current Chief Complaint: Bilateral scrotal swelling. History of the Present Illness: The patient had experienced painless swelling of his scrotum for the past 2 years. At the time of clinical examination, any movement caused scrotal discomfort; he described experiencing a pulsing dull ache while in a standing position that resolved itself when he lay down. The patient was lethargic and easily fatigued; he experienced dyspnea on exertion. He reported no chest pain, difficulty in breathing, or night sweats. He had unintentionally lost 15 pounds during the past 10 months. He had experienced no changes in his bowel or urinary habits and no change in his appetite. Drug Allergies: No known drug allergies. Current Medications: None. Family History: The patient's father had a history of liver disease; no diagnostic work-up was performed on the father. Social History: The patient was a college student; he was single; had no history of tobacco, alcohol, or intravenous drug use, and he was not sexually active. There was no history of recent travel or contact sports. Physical Exam Vital Signs: Blood pressure, 95/77 mm/Hg; temperature, 36.8° C; weight, 72.6 kg; body mass index (calculated as the weight in kilograms divided by height in meters squared), 29; respiratory rate, 16 breaths/minute; pulse, 64 beats/minute. General: In no acute distress. Head, Eyes, Ears, Nose, and Throat: No enlarged lymph nodes and no scleral icterius. Neck: No jugular venous distension, thyroid normal, no bruits, and no adenopathic manifestations. Breast: Bilateral gynecomastia without tenderness. Respiratory: Good air entry, clear to auscultation with dullness to percussion of the lower third of the right lung, no crepitation or crackles. Cardiovascular: Regular heart rate; normal S1 and S2; no murmurs, gallops, clicks, or rubs. Gastrointestinal: Soft, nontender, normal bowel sounds; mild distension; no shifting dullness; hepatosplenomegaly noted. Extremities: No pitting edema or clubbing. Genitourinary: Enlarged scrotum, negative Prehn sign, scrotal transillumination did not reveal a dense mass, no change in skin color, no penile discharge.
All Science Journal Classification (ASJC) codes
- Clinical Biochemistry
- Biochemistry, medical