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__NOTOC__
__NOTOC__
{{Testicular torsion}}
{{Testicular torsion}}
{{CMG}}; {{AE}} {{HK}}
==Overview==
Testicular torsion should be differentiated from other conditions presenting with [[lower abdominal pain]], [[nausea and vomiting]].
==Differentiating Testicular Torsion From Other Diseases==
Testicular torsion should be differentiated from other conditions presenting with [[lower abdominal pain]] , [[nausea and vomiting]]. The differentials include the following:<ref name="pmid18486720">{{cite journal |vauthors=Worcester EM, Coe FL |title=Nephrolithiasis |journal=Prim. Care |volume=35 |issue=2 |pages=369–91, vii |date=June 2008 |pmid=18486720 |pmc=2518455 |doi=10.1016/j.pop.2008.01.005 |url=}}</ref><ref name="pmid21789078">{{cite journal |vauthors=Semins MJ, Matlaga BR |title=Medical evaluation and management of urolithiasis |journal=Ther Adv Urol |volume=2 |issue=1 |pages=3–9 |date=February 2010 |pmid=21789078 |pmc=3126068 |doi=10.1177/1756287210369121 |url=}}</ref><ref name="pmid28764263">{{cite journal |vauthors=Venkatesh L, Hanumegowda RK |title=Acute Pyelonephritis - Correlation of Clinical Parameter with Radiological Imaging Abnormalities |journal=J Clin Diagn Res |volume=11 |issue=6 |pages=TC15–TC18 |date=June 2017 |pmid=28764263 |pmc=5535453 |doi=10.7860/JCDR/2017/27247.10033 |url=}}</ref><ref name="pmid17375337">{{cite journal |vauthors=Garin EH, Olavarria F, Araya C, Broussain M, Barrera C, Young L |title=Diagnostic significance of clinical and laboratory findings to localize site of urinary infection |journal=Pediatr. Nephrol. |volume=22 |issue=7 |pages=1002–6 |date=July 2007 |pmid=17375337 |doi=10.1007/s00467-007-0465-7 |url=}}</ref><ref name="pmid19399273">{{cite journal |vauthors=Lee DG, Jeon SH, Lee CH, Lee SJ, Kim JI, Chang SG |title=Acute pyelonephritis: clinical characteristics and the role of the surgical treatment |journal=J. Korean Med. Sci. |volume=24 |issue=2 |pages=296–301 |date=April 2009 |pmid=19399273 |pmc=2672131 |doi=10.3346/jkms.2009.24.2.296 |url=}}</ref><ref name="pmid22969301">{{cite journal |vauthors=Saeed K |title=Renal infarction |journal=Int J Nephrol Renovasc Dis |volume=5 |issue= |pages=119–23 |date=2012 |pmid=22969301 |pmc=3437809 |doi=10.2147/IJNRD.S33768 |url=}}</ref><ref name="pmid24812524">{{cite journal |vauthors=Mahamid M, Francis A, Abid A, Awawde M, Abu-Elhija O |title=Embolic renal infarction mimicking renal colic |journal=Int J Nephrol Renovasc Dis |volume=7 |issue= |pages=157–9 |date=2014 |pmid=24812524 |pmc=4011809 |doi=10.2147/IJNRD.S59745 |url=}}</ref><ref name="pmid12389340">{{cite journal |vauthors=Korzets Z, Plotkin E, Bernheim J, Zissin R |title=The clinical spectrum of acute renal infarction |journal=Isr. Med. Assoc. J. |volume=4 |issue=10 |pages=781–4 |date=October 2002 |pmid=12389340 |doi= |url=}}</ref><ref name="pmid12512867">{{cite journal |vauthors=Brix AE |title=Renal papillary necrosis |journal=Toxicol Pathol |volume=30 |issue=6 |pages=672–4 |date=2002 |pmid=12512867 |doi=10.1080/01926230290166760 |url=}}</ref><ref name="pmid7038374">{{cite journal |vauthors=Eknoyan G, Qunibi WY, Grissom RT, Tuma SN, Ayus JC |title=Renal papillary necrosis: an update |journal=Medicine (Baltimore) |volume=61 |issue=2 |pages=55–73 |date=March 1982 |pmid=7038374 |doi= |url=}}</ref><ref name="pmid18806169">{{cite journal |vauthors=Ng CS, Wood CG, Silverman PM, Tannir NM, Tamboli P, Sandler CM |title=Renal cell carcinoma: diagnosis, staging, and surveillance |journal=AJR Am J Roentgenol |volume=191 |issue=4 |pages=1220–32 |date=October 2008 |pmid=18806169 |doi=10.2214/AJR.07.3568 |url=}}</ref><ref name="pmid15536955">{{cite journal |vauthors=Ares Valdés Y, Amador Sandoval B, Morales JC, Alonso Domínguez F, Carballo Velásquez L, Fragas Valdés R, Shou Rodríguez A |title=[The role of CT scan in the diagnosis of renal cell carcinoma] |language=Spanish; Castilian |journal=Arch. Esp. Urol. |volume=57 |issue=7 |pages=737–42 |date=September 2004 |pmid=15536955 |doi= |url=}}</ref><ref name="pmid20479778">{{cite journal |vauthors=Leveridge MJ, Bostrom PJ, Koulouris G, Finelli A, Lawrentschuk N |title=Imaging renal cell carcinoma with ultrasonography, CT and MRI |journal=Nat Rev Urol |volume=7 |issue=6 |pages=311–25 |date=June 2010 |pmid=20479778 |doi=10.1038/nrurol.2010.63 |url=}}</ref><ref name="pmid23596502">{{cite journal |vauthors=Tritschler S, Roosen A, Füllhase C, Stief CG, Rübben H |title=Urethral stricture: etiology, investigation and treatments |journal=Dtsch Arztebl Int |volume=110 |issue=13 |pages=220–6 |date=March 2013 |pmid=23596502 |pmc=3627163 |doi=10.3238/arztebl.2013.0220 |url=}}</ref><ref name="pmid21176068">{{cite journal |vauthors=Mundy AR, Andrich DE |title=Urethral strictures |journal=BJU Int. |volume=107 |issue=1 |pages=6–26 |date=January 2011 |pmid=21176068 |doi=10.1111/j.1464-410X.2010.09800.x |url=}}</ref><ref name="pmid26816803">{{cite journal |vauthors=Maciejewski C, Rourke K |title=Imaging of urethral stricture disease |journal=Transl Androl Urol |volume=4 |issue=1 |pages=2–9 |date=February 2015 |pmid=26816803 |pmc=4708283 |doi=10.3978/j.issn.2223-4683.2015.02.03 |url=}}</ref><ref name="pmid20664404">{{cite journal |vauthors=Soper DE |title=Pelvic inflammatory disease |journal=Obstet Gynecol |volume=116 |issue=2 Pt 1 |pages=419–28 |date=August 2010 |pmid=20664404 |doi=10.1097/AOG.0b013e3181e92c54 |url=}}</ref><ref name="pmid9891675">{{cite journal |vauthors=Paavonen J |title=Pelvic inflammatory disease. From diagnosis to prevention |journal=Dermatol Clin |volume=16 |issue=4 |pages=747–56, xii |date=October 1998 |pmid=9891675 |doi= |url=}}</ref><ref name="pmid24802548">{{cite journal |vauthors=Lee MH, Moon MH, Sung CK, Woo H, Oh S |title=CT findings of acute pelvic inflammatory disease |journal=Abdom Imaging |volume=39 |issue=6 |pages=1350–5 |date=December 2014 |pmid=24802548 |doi=10.1007/s00261-014-0158-1 |url=}}</ref><ref name="pmid17054801">{{cite journal |vauthors=Eggert J, Sundquist K, van Vuuren C, Fianu-Jonasson A |title=The clinical diagnosis of pelvic inflammatory disease--reuse of electronic medical record data from 189 patients visiting a Swedish university hospital emergency department |journal=BMC Womens Health |volume=6 |issue= |pages=16 |date=October 2006 |pmid=17054801 |pmc=1624808 |doi=10.1186/1472-6874-6-16 |url=}}</ref><ref name="pmid24294125">{{cite journal |vauthors=Washington C, Carmichael JC |title=Management of ischemic colitis |journal=Clin Colon Rectal Surg |volume=25 |issue=4 |pages=228–35 |date=December 2012 |pmid=24294125 |pmc=3577613 |doi=10.1055/s-0032-1329534 |url=}}</ref><ref name="pmid25941431">{{cite journal |vauthors=Chawla YK, Bodh V |title=Portal vein thrombosis |journal=J Clin Exp Hepatol |volume=5 |issue=1 |pages=22–40 |date=March 2015 |pmid=25941431 |pmc=4415192 |doi=10.1016/j.jceh.2014.12.008 |url=}}</ref><ref name="urlImaging of Abdominal Aortic Aneurysms - - American Family Physician">{{cite web |url=https://www.aafp.org/afp/2002/0415/p1565.html |title=Imaging of Abdominal Aortic Aneurysms - - American Family Physician |format= |work= |accessdate=}}</ref><ref name="pmid21523201">{{cite journal |vauthors=Aggarwal S, Qamar A, Sharma V, Sharma A |title=Abdominal aortic aneurysm: A comprehensive review |journal=Exp Clin Cardiol |volume=16 |issue=1 |pages=11–5 |date=2011 |pmid=21523201 |pmc=3076160 |doi= |url=}}</ref><ref name="pmid20676257">{{cite journal |vauthors=Destigter KK, Keating DP |title=Imaging update: acute colonic diverticulitis |journal=Clin Colon Rectal Surg |volume=22 |issue=3 |pages=147–55 |date=August 2009 |pmid=20676257 |pmc=2780264 |doi=10.1055/s-0029-1236158 |url=}}</ref><ref name="pmid24888393">{{cite journal |vauthors=Hameed AM, Lam VW, Pleass HC |title=Significant elevations of serum lipase not caused by pancreatitis: a systematic review |journal=HPB (Oxford) |volume=17 |issue=2 |pages=99–112 |date=February 2015 |pmid=24888393 |pmc=4299384 |doi=10.1111/hpb.12277 |url=}}</ref><ref name="urlImaging for Suspected Appendicitis - - American Family Physician">{{cite web |url=https://www.aafp.org/afp/2005/0101/p71.html |title=Imaging for Suspected Appendicitis - - American Family Physician |format= |work= |accessdate=}}</ref><ref name="urlCT Findings of Acute Cholecystitis and Its Complications : American Journal of Roentgenology : Vol. 194, No. 6 (AJR)">{{cite web |url=https://www.ajronline.org/doi/full/10.2214/AJR.09.3640 |title=CT Findings of Acute Cholecystitis and Its Complications : American Journal of Roentgenology : Vol. 194, No. 6 (AJR) |format= |work= |accessdate=}}</ref><ref name="urlEpididymitis and Orchitis: An Overview - - American Family Physician">{{cite web |url=https://www.aafp.org/afp/2009/0401/p583.html |title=Epididymitis and Orchitis: An Overview - - American Family Physician |format= |work= |accessdate=}}</ref><ref name="pmid26526901">{{cite journal |vauthors=Jia JB, Houshyar R, Verma S, Uchio E, Lall C |title=Prostate cancer on computed tomography: A direct comparison with multi-parametric magnetic resonance imaging and tissue pathology |journal=Eur J Radiol |volume=85 |issue=1 |pages=261–267 |date=January 2016 |pmid=26526901 |doi=10.1016/j.ejrad.2015.10.013 |url=}}</ref><ref name="pmid25393274">{{cite journal |vauthors=Bratt O, Lilja H |title=Serum markers in prostate cancer detection |journal=Curr Opin Urol |volume=25 |issue=1 |pages=59–64 |date=January 2015 |pmid=25393274 |pmc=4315142 |doi=10.1097/MOU.0000000000000128 |url=}}</ref><ref name="urlProstate Cancer (Prostate Carcinoma): Symptoms - National Library of Medicine - PubMed Health">{{cite web |url=https://www.ncbi.nlm.nih.gov/pubmedhealth/PMHT0024422/ |title=Prostate Cancer (Prostate Carcinoma): Symptoms - National Library of Medicine - PubMed Health |format= |work= |accessdate=}}</ref><ref name="pmid25675798">{{cite journal |vauthors=Eskicioğlu F, Özdemir AT, Turan GA, Gür EB, Kasap E, Genç M |title=The efficacy of complete blood count parameters in the diagnosis of tubal ectopic pregnancy |journal=Ginekol. Pol. |volume=85 |issue=11 |pages=823–7 |date=November 2014 |pmid=25675798 |doi= |url=}}</ref><ref name="pmid21727242">{{cite journal |vauthors=Sivalingam VN, Duncan WC, Kirk E, Shephard LA, Horne AW |title=Diagnosis and management of ectopic pregnancy |journal=J Fam Plann Reprod Health Care |volume=37 |issue=4 |pages=231–40 |date=October 2011 |pmid=21727242 |pmc=3213855 |doi=10.1136/jfprhc-2011-0073 |url=}}</ref>


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{| class="wikitable"
! rowspan="2" align="center" style="background:#4479BA; color: #FFFFFF;" + |Category
! rowspan="2" align="center" style="background:#4479BA; color: #FFFFFF;" + |Disease
! rowspan="2" align="center" style="background:#4479BA; color: #FFFFFF;" + |History
! colspan="11" align="center" style="background:#4479BA; color: #FFFFFF;" + |Signs and Symptoms
! colspan="3" align="center" style="background:#4479BA; color: #FFFFFF;" + |Physical Examination
! colspan="10" align="center" style="background:#4479BA; color: #FFFFFF;" + |Laboratory abnormalities
|-
! align="center" style="background:#4479BA; color: #FFFFFF;" + |'''Nausea/vomiting'''
! align="center" style="background:#4479BA; color: #FFFFFF;" + |'''Hematuria'''
! align="center" style="background:#4479BA; color: #FFFFFF;" + |'''Location of pain'''
! align="center" style="background:#4479BA; color: #FFFFFF;" + |'''Fever'''
! align="center" style="background:#4479BA; color: #FFFFFF;" + |'''Tachycardia'''
! align="center" style="background:#4479BA; color: #FFFFFF;" + |'''Hypotension'''
! align="center" style="background:#4479BA; color: #FFFFFF;" + |'''Hypertension'''
! align="center" style="background:#4479BA; color: #FFFFFF;" + |'''Anorexia'''
! align="center" style="background:#4479BA; color: #FFFFFF;" + |'''Constipation'''
! align="center" style="background:#4479BA; color: #FFFFFF;" + |'''Rebound abdominal tenderness'''
! align="center" style="background:#4479BA; color: #FFFFFF;" + |'''Urinary frequency/Urgency/Dysuria'''
! align="center" style="background:#4479BA; color: #FFFFFF;" + |'''Costovetebral angle tenderness'''
! align="center" style="background:#4479BA; color: #FFFFFF;" + |'''Pelvic Examination'''
! align="center" style="background:#4479BA; color: #FFFFFF;" + |'''Rectal Examination'''
! align="center" style="background:#4479BA; color: #FFFFFF;" + |'''Complete Blood Count (CBC)'''
! align="center" style="background:#4479BA; color: #FFFFFF;" + |'''Urinalysis'''
! align="center" style="background:#4479BA; color: #FFFFFF;" + |'''BUN'''
! align="center" style="background:#4479BA; color: #FFFFFF;" + |'''Creatinine'''
! align="center" style="background:#4479BA; color: #FFFFFF;" + |'''Stone analysis'''
! align="center" style="background:#4479BA; color: #FFFFFF;" + |'''Urine Beta- hCG'''
! align="center" style="background:#4479BA; color: #FFFFFF;" + |'''Abnormal Liver Function Tests (LFTs)'''
! align="center" style="background:#4479BA; color: #FFFFFF;" + |'''Serum Amylase/Lipase'''
! align="center" style="background:#4479BA; color: #FFFFFF;" + |'''Abdominal/Pelvic CT scan'''
! align="center" style="background:#4479BA; color: #FFFFFF;" + |'''Serum Parathyroid hormone levels (PTH)'''
|-
| rowspan="6" |
=== Renal Pathology ===
|'''Nephrolithiasis'''
|
* Primary hyper parathyroidism
* Inadequate dietary [[calcium]] intake
* [[Hypercalciuria]]
* [[Hyperoxaluria]]
* [[Cystinuria]]
* [[Renal tubular acidosis]]
* Infection with urease producing bacteria (''[[Ureaplasma urealyticum]]'', ''Klebsiella'', ''Protues'')
|<nowiki>+</nowiki>
|<nowiki>+</nowiki>
|
* [[Flank Pain|Flank]]/[[back pain]] radiating to groin
|<nowiki>-</nowiki>
|<nowiki>+</nowiki>
|<nowiki>-</nowiki>
| -
|<nowiki>+/-</nowiki>
|<nowiki>-</nowiki>
|<nowiki>-</nowiki>
|<nowiki>+</nowiki>
|<nowiki>-</nowiki>
|<nowiki>-</nowiki>
|<nowiki>-</nowiki>
|<nowiki>-</nowiki>
|
|
|
|
|<nowiki>-</nowiki>
|<nowiki>-</nowiki>
|<nowiki>-</nowiki>
|
* Non-contrast [[Computed tomography|CT scan]] may show stone as radiolucency
|<nowiki>+/-</nowiki>
|-
|'''[[Pyelonephritis]]'''
|
* [[Urinary tract infection]]
* [[Immunocompromised|Immunocompromised state]] ([[Diabetes]], [[Immunosuppresive drug|immunosuppressive]] medications)
* [[Urinary tract obstruction]]
* History of [[pyelonephritis]]
* [[Pregnancy]]
* Presence of [[urinary catheter]], [[stent]], [[nephrostomy]] tube
|<nowiki>+</nowiki>
|<nowiki>+ (microscopic)</nowiki>
|
* [[Costovertebral angle]]
* Positive renal punch sign
|<nowiki>+</nowiki>
|<nowiki>+</nowiki>
|<nowiki>+</nowiki>
| -
|<nowiki>+/-</nowiki>
|<nowiki>-</nowiki>
|<nowiki>+</nowiki>
|<nowiki>+</nowiki>
|<nowiki>+</nowiki>
|
* [[Urethritis]]
* [[Vaginitis]]
|<nowiki>-</nowiki>
|
* [[Leukocytosis]]
|
* [[Pyuria]]
* Positive [[leukocyte esterase]]
|
|
|<nowiki>-</nowiki>
| -
|<nowiki>-</nowiki>
|<nowiki>-</nowiki>
|
* Globaly decreased contrast uptake
*  Foci from [[abscess]] pockets
|<nowiki>-</nowiki>
|-
|'''[[Renal infarct]]'''
|
* [[Sickle-cell disease|Sickle cell disease]] or trait
* [[Thrombosis]]
* [[Trauma]]
* [[Hypertension]]
* [[Cardiac arrhythmia]]
* [[Coagulopathy]]
* [[Atherosclerosis]]
|<nowiki>+</nowiki>
|<nowiki>+</nowiki>
|
* [[Flank pain]]
|<nowiki>+</nowiki>
|<nowiki>+</nowiki>
|<nowiki>-</nowiki>
| +
|<nowiki>-</nowiki>
|<nowiki>-</nowiki>
|<nowiki>-</nowiki>
|<nowiki>-</nowiki>
|<nowiki>-</nowiki>
|<nowiki>-</nowiki>
|<nowiki>-</nowiki>
|
* [[Leukocytosis]]
|
* [[Red blood cell|Red blood cells]]
* [[Proteinuria]]
|
|
|<nowiki>-</nowiki>
|<nowiki>-</nowiki>
|
|
|
|<nowiki>-</nowiki>
|-
|'''[[Renal papillary necrosis]]'''
|
* [[Analgesic]] use ([[Phenacetin]], [[acetaminophen]], [[NSAIDs]])
* [[Pyelonephritis]]
* [[Urinary tract obstruction]]
* [[Sickle cell disease]]
* [[Tuberculosis]]
* [[Cirrhosis]]
* [[Diabetes]]
* [[Vasculitis]]
* [[Renal vein thrombosis]]
|<nowiki>-</nowiki>
|<nowiki>+ (microscopic)</nowiki>
|
* [[Flank pain]]
|<nowiki>+</nowiki>
|<nowiki>+/-</nowiki>
|<nowiki>-</nowiki>
| +
|<nowiki>-</nowiki>
|<nowiki>-</nowiki>
|<nowiki>-</nowiki>
|<nowiki>+</nowiki>
|<nowiki>-</nowiki>
|<nowiki>-</nowiki>
|<nowiki>-</nowiki>
|
|
* [[Bacteriuria]]
* [[Pyuria]]
* [[Microscopic hematuria]]
|
|
|<nowiki>-</nowiki>
|<nowiki>-</nowiki>
|<nowiki>-</nowiki>
|<nowiki>-</nowiki>
|
* Blunted [[renal calyces]]
* Contrast material–filled clefts in the [[renal medulla]]
* Non-enhanced lesions surrounded by rings of excreted contrast material
* Hyperattenuated [[medullary]] [[Calcification|calcifications]]
|<nowiki>-</nowiki>
|-
|'''[[Renal cell carcinoma]]'''
|
* [[Weight loss]]
* History of [[smoking]]
* [[Obesity]]
* [[Von Hippel-Lindau disease|Von-Hippel Lindau disease]]
* [[Night sweats]]
* [[Malaise]]
* Flank mass
| +
|<nowiki>+ (microscopic)</nowiki>
|
* [[Flank pain]]
|<nowiki>-</nowiki>
|<nowiki>-</nowiki>
|<nowiki>-</nowiki>
| +
|<nowiki>+</nowiki>
|<nowiki>+/-</nowiki>
|<nowiki>-</nowiki>
|<nowiki>-</nowiki>
|<nowiki>-</nowiki>
|<nowiki>-</nowiki>
|<nowiki>-</nowiki>
|
* Anemia
|
* [[Microscopic hematuria]]
* Renal cell casts
* Urinary [[Aquaporin 1|aquaporin-1]] (AQP1) and adipophilin (ADFP)- [[Renal cell carcinoma|proximal renal tubular cancer]]
|
|
|<nowiki>-</nowiki>
|<nowiki>-</nowiki>
| -
|<nowiki>-</nowiki>
|
* Non-contrast CT:
** Lesions are [[soft tissue]] attenuation 
** Areas of [[calcification]] and [[necrosis]]
* Contrast-enhanced:
** Homogenous (small lesions) to irregular  (large lesions) contrast enhancement
|<nowiki>-</nowiki>
|-
|'''Uretral stricture'''
|
* Prior [[urinary tract]] surgery
* [[Congenital]]
* [[Urinary catheterization]]
* Direct [[Penis|penile]] trauma
|<nowiki>-</nowiki>
|<nowiki>+/-</nowiki>
|<nowiki>-</nowiki>
|<nowiki>-</nowiki>
|<nowiki>-</nowiki>
|<nowiki>-</nowiki>
|<nowiki>-</nowiki>
|<nowiki>-</nowiki>
|<nowiki>-</nowiki>
|<nowiki>-</nowiki>
|<nowiki>+</nowiki>
|<nowiki>-</nowiki>
|<nowiki>-</nowiki>
|<nowiki>-</nowiki>
|<nowiki>-</nowiki>
|<nowiki>-</nowiki>
|
|
|<nowiki>-</nowiki>
|<nowiki>-</nowiki>
|<nowiki>-</nowiki>
|<nowiki>-</nowiki>
|<nowiki>-</nowiki>
|<nowiki>-</nowiki>
|-
| rowspan="3" |
=== Prostate Pathology ===
|'''[[Prostatitis]]'''
|
* Bacterial infection by:
** ''[[Ureaplasma urealyticum]]''
** ''[[Proteus]]''
** ''[[Chlamydia]]''
** ''[[Gonorrhea]]''
** ''[[E.Coli]]''
** ''[[Pseudomonas]]''
** ''[[Mycoplasma]]''
* Prior history of [[prostatitis]]
* [[Urinary tract infection]]
* [[Urinary catheterization]]
|<nowiki>-</nowiki>
|<nowiki>+</nowiki>
|
* [[Perineal]] pain
* [[Lower back pain]]
* Suprapubic pain
|<nowiki>+</nowiki>
|<nowiki>+</nowiki>
|<nowiki>-</nowiki>
|<nowiki>-</nowiki>
|<nowiki>-</nowiki>
|<nowiki>-</nowiki>
|<nowiki>-</nowiki>
|<nowiki>+</nowiki>
|<nowiki>-</nowiki>
|<nowiki>-</nowiki>
|
* Enlarged [[prostate]]
* [[Rectal pain]]
|
* [[Leukocytosis]]
|
* [[Bacteriuria]]
* [[Pyuria]]
* [[Microscopic hematuria]]
|<nowiki>-</nowiki>
|<nowiki>-</nowiki>
|<nowiki>-</nowiki>
|<nowiki>-</nowiki>
|<nowiki>-</nowiki>
|<nowiki>-</nowiki>
|
|<nowiki>-</nowiki>
|-
|'''[[Prostatic cancer]]'''
|
* [[Family history]] of [[Prostate cancer|prostate cance]]<nowiki/>r (1st degree relatives)
* [[Germline mutation]] of [[HOXB13]] (G84E variant)
* Black ethnicity
* Age > 50 years
|<nowiki>-</nowiki>
|<nowiki>+</nowiki>
|<nowiki>-</nowiki>
|<nowiki>-</nowiki>
|<nowiki>-</nowiki>
|<nowiki>-</nowiki>
|<nowiki>-</nowiki>
|<nowiki>+</nowiki>
|<nowiki>-</nowiki>
|<nowiki>-</nowiki>
|<nowiki>+</nowiki>
|<nowiki>-</nowiki>
|<nowiki>-</nowiki>
|
* Enlarged [[prostate]]
* Firm and hard
|<nowiki>-</nowiki>
|
* Positive [[prostate specific antigen]] (PSA)
* High levels of [[TMPRSS2]]:ERG and [[PCA3]]
|
|
|<nowiki>-</nowiki>
|<nowiki>-</nowiki>
|<nowiki>-</nowiki>
|<nowiki>-</nowiki>
|
* Focal areas of mass-like enhancement in the peripheral [[prostate]]
* [[Calcification|Calcifications]]
|<nowiki>-</nowiki>
|-
| rowspan="2" |
=== Testicular Pathology ===
|'''[[Testicular torsion]]'''
|
* Age 12 - 16 years
* Previous history of [[testicular torsion]]
* [[Family history]] of [[testicular torsion]]
* [[Prematurity]]
* [[Undescended testes]]
* [[Low birth weight]]
|<nowiki>+</nowiki>
|<nowiki>-</nowiki>
|
* Sudden onset unilateral [[testicular pain]]
|<nowiki>-</nowiki>
|<nowiki>+</nowiki>
|<nowiki>-</nowiki>
|<nowiki>-</nowiki>
|<nowiki>+/-</nowiki>
|<nowiki>-</nowiki>
|<nowiki>-</nowiki>
|<nowiki>+/-</nowiki>
|<nowiki>-</nowiki>
|
* Absent [[cremasteric reflex]]
* [[Testicle]] may be swollen, tender, and high-riding, with an abnormal transverse lie.
|<nowiki>-</nowiki>
|<nowiki>-</nowiki>
|<nowiki>-</nowiki>
|<nowiki>-</nowiki>
|<nowiki>-</nowiki>
|<nowiki>-</nowiki>
|<nowiki>-</nowiki>
|<nowiki>-</nowiki>
|<nowiki>-</nowiki>
|
* [[Doppler ultrasound]] > [[Computed tomography|CT scan]] for diagnosis (abscence of [[blood]] flow in the affected [[Testicle|testis]])
|<nowiki>-</nowiki>
|-
|'''[[Orchitis]]'''
|
* Unprotected sexual intercourse
* [[Mumps]], [[Coxsackie virus|coxsackie]] virus infection
* Concurrent [[epididymitis]]
* [[Congenital disorder|Congenital abnornmalities]]
* [[Prostatitis]]
* [[Prostatic hypertrophy]] or [[calculi]]
|<nowiki>+</nowiki>
|<nowiki>-</nowiki>
|
* Abrupt onset of [[testicular pain]]
|<nowiki>+</nowiki>
|<nowiki>+</nowiki>
|<nowiki>-</nowiki>
|<nowiki>-</nowiki>
|<nowiki>-</nowiki>
|<nowiki>-</nowiki>
|<nowiki>-</nowiki>
|<nowiki>+/-</nowiki>
|<nowiki>-</nowiki>
|
* Testicular swelling and tenderness
* Normal [[cremasteric reflex]]
|<nowiki>-</nowiki>
|
* [[Leukocytosis]]
|<nowiki>-</nowiki>
|<nowiki>-</nowiki>
|<nowiki>-</nowiki>
|<nowiki>-</nowiki>
|<nowiki>-</nowiki>
|<nowiki>-</nowiki>
|<nowiki>-</nowiki>
|
* [[Ultrasound]] > [[Computed tomography|CT scan]] for diagnosis ([[Testicular masses]] or swollen [[testicles]] with hypoechoic and hypervascular areas)
|<nowiki>-</nowiki>
|-
| rowspan="7" |
=== Abdominal Pathology ===
|'''[[Cholecystitis]]'''
|
* Female gender
* [[Obesity]]
* [[Pregnancy]] (increased [[progesterone]] promotes biliary stasis)
* Rapid [[weight loss]]
* [[Oral contraceptive|Oral contraceptive use]]
* Increasing age
* [[Total parenteral nutrition]]
|<nowiki>+</nowiki>
|<nowiki>-</nowiki>
|
* [[Right upper quadrant pain|Right upper abdominal quadrant pain]]
* [[Flank pain]]
|<nowiki>+</nowiki>
|<nowiki>+</nowiki>
|<nowiki>-</nowiki>
|<nowiki>-</nowiki>
|<nowiki>+</nowiki>
|<nowiki>-</nowiki>
|<nowiki>-</nowiki>
|<nowiki>-</nowiki>
|<nowiki>-</nowiki>
|<nowiki>-</nowiki>
|<nowiki>-</nowiki>
|
* [[Leukocytosis]]
|<nowiki>-</nowiki>
|<nowiki>-</nowiki>
|<nowiki>-</nowiki>
|
* [[Bilirubin]] (pigment) stones
* [[Cholesterol]] stones
|<nowiki>-</nowiki>
|<nowiki>+</nowiki>
| +/-
|
* [[Gallbladder]] distention
* Wall thickening
* Mucosal hyperenhancement,
* Pericholecystic fat stranding or fluid
* [[Gallstones]]
 
|<nowiki>-</nowiki>
|-
|'''[[Appendicitis]]'''
|
* Male gender
* [[Adolescent|Adolescents]]
* Diet low in fiber and high in refined [[carbohydrates]]
* History of [[appendicitis]] in first degree relatives
|<nowiki>+</nowiki>
|<nowiki>-</nowiki>
|
* [[Pain]] in umblical area
* Radiating to [[Right lower quadrant abdominal pain resident survival guide|right lower abdominal quadrant]]
|<nowiki>+</nowiki>
|<nowiki>+</nowiki>
|<nowiki>-</nowiki>
|<nowiki>-</nowiki>
|<nowiki>+</nowiki>
|<nowiki>-</nowiki>
|<nowiki>+</nowiki>
|<nowiki>+/-</nowiki>
|<nowiki>-</nowiki>
|<nowiki>-</nowiki>
|<nowiki>-</nowiki>
|
* Leukocytosis
|<nowiki>-</nowiki>
|<nowiki>-</nowiki>
|<nowiki>-</nowiki>
|<nowiki>-</nowiki>
|<nowiki>-</nowiki>
|<nowiki>-</nowiki>
| + (if perforation)
|
* Larger than 6 mm in diameter,
* [[Vermiform appendix|Appendiceal]] wall thickening
* Wall enhancement after contrast media infusion
* [[Inflammatory]] fat stranding
* [[Phlegmon]]
* Free fluid
* Free air bubbles
* [[Abscess]]
* [[Adenopathy]]
|<nowiki>-</nowiki>
|-
|'''[[Diverticulitis]]'''
|
* [[Diverticulosis]]
* Low [[Fiber|fiber diet]]
* Old age
|<nowiki>+</nowiki>
|<nowiki>-</nowiki>
|
* [[Left lower quadrant abdominal pain resident survival guide|Left lower abdominal quadrant]]
|<nowiki>+</nowiki>
|<nowiki>+</nowiki>
|<nowiki>-</nowiki>
|<nowiki>-</nowiki>
|<nowiki>+</nowiki>
|<nowiki>+</nowiki>
|<nowiki>-</nowiki>
|<nowiki>-</nowiki>
|<nowiki>-</nowiki>
|<nowiki>-</nowiki>
|
* [[Bleeding]]
* [[Rectal masses|Rectal mass]]
* [[Rectal]] [[tenderness]]
|
* [[Leukocytosis]]
|<nowiki>-</nowiki>
|<nowiki>-</nowiki>
|<nowiki>-</nowiki>
|<nowiki>-</nowiki>
|<nowiki>-</nowiki>
|<nowiki>-</nowiki>
| + (if [[Perforation of inflamed diverticulum|perforation]])
|
* [[Colon|Colonic]] wall thickening (wall thickness is greater than 3 mm on the short axis of the lumen)
* Pericolic fat stranding
|<nowiki>-</nowiki>
|-
|'''[[Abdominal aortic aneurysm]]'''
|
* [[Hypertension]]
* [[Cigarette smoking]]
* [[Pulsatile Flow|Pulsatile]] [[abdominal mass]]
|<nowiki>-</nowiki>
|<nowiki>-</nowiki>
|
* [[Epigastric pain]]
* Deep boring [[pain]] in the [[back]]
* May radiate to [[flank]]
|<nowiki>-</nowiki>
|<nowiki>+</nowiki>
|<nowiki>+</nowiki>
|<nowiki>-</nowiki>
|<nowiki>-</nowiki>
|<nowiki>-</nowiki>
|<nowiki>+ (if rupture)</nowiki>
|<nowiki>-</nowiki>
|<nowiki>-</nowiki>
|<nowiki>-</nowiki>
|<nowiki>-</nowiki>
|<nowiki>-</nowiki>
|<nowiki>-</nowiki>
|<nowiki>-</nowiki>
|<nowiki>-</nowiki>
|<nowiki>-</nowiki>
|<nowiki>-</nowiki>
|<nowiki>-</nowiki>
|<nowiki>-</nowiki>
|
* Ultrasound more sensitive than CT scan
* CT scan may accurately predict the aneurysmal size
* Helical CT has faster scanning time (30 to 60 seconds) and the ability to obtain all images in one breath hold
|<nowiki>-</nowiki>
|-
|'''[[Portal vein thrombosis]]'''
|
* Mutated JAK2 V617F
* [[Antiphospholipid syndrome|Anti-phospholipid syndrome]]
* [[Paroxysmal nocturnal hemoglobinuria]]
* [[Homocysteinuria]]
* [[Factor V Leiden]]
* [[Prothrombin G20210A mutation|Prothrombin mutation G20210A]]
* [[Protein C deficiency|Protein C]] or [[Protein S deficiency|S deficiency]]
* [[Oral contraceptive|Oral contraceptive use]]
* [[Cirrhosis]]
* [[Pregnancy]] and [[post-partum]]
|<nowiki>+</nowiki>
|<nowiki>-</nowiki>
|
* [[Abdominal]] or [[lumbar pain]]
|<nowiki>+</nowiki>
|<nowiki>+</nowiki>
|<nowiki>+</nowiki>
|<nowiki>-</nowiki>
|<nowiki>+</nowiki>
|<nowiki>-</nowiki>
| + (if [[bowel]] [[ischemia]] or [[infarction]]-secondary to extension of [[thrombus]] to [[superior mesenteric vein]])
|<nowiki>-</nowiki>
|<nowiki>-</nowiki>
|<nowiki>-</nowiki>
|
* [[Hematochezia]]
|
* [[Anemia]]
* [[Thrombocytopenia]]
|<nowiki>-</nowiki>
|<nowiki>-</nowiki>
|<nowiki>-</nowiki>
|<nowiki>-</nowiki>
|<nowiki>-</nowiki>
|<nowiki>+</nowiki>
| + (if [[bowel]] [[infarction]], [[perforation]])
|
* On non-contrast CT:
** Hyperdense thrombus
* On contrast CT
** Non-enhancing defect of bland thrombus
** Tumor thrombus exhibits enhancement
|
|-
|'''[[Duodenal ulcer]]'''
|
* Pain relieved by intake of food
* [[Helicobacter pylori infection]]
* [[Tobacco smoking]]
* [[NSAID|NSAID use]]
* [[Alcohol|EtOH use]]
* Older age
* Female gender
* [[Family history]] of [[Duodenal ulcer|duodenal ulcers]]
|<nowiki>+</nowiki>
|<nowiki>-</nowiki>
|
* [[Epigastric pain]]
|<nowiki>+</nowiki>
|<nowiki>+</nowiki>
|<nowiki>+</nowiki>
|<nowiki>-</nowiki>
|<nowiki>-</nowiki>
|<nowiki>-</nowiki>
| + (if [[Bowel perforation|perforation]])
|<nowiki>-</nowiki>
|<nowiki>-</nowiki>
|<nowiki>-</nowiki>
|
* [[Melena]]
|
* [[Anemia]]
|<nowiki>-</nowiki>
|
|
|<nowiki>-</nowiki>
|<nowiki>-</nowiki>
|<nowiki>-</nowiki>
| + (if [[bowel perforation]])
|
* [[Endoscopy]] > [[CT scan]] for diagnosis
|<nowiki>-</nowiki>
|-
|'''[[Ischemic colitis]]'''
|
* Age > 60 years
* [[Hemodialysis]]
* [[Hypertension]]
* [[Hypoalbuminemia]]
* [[Diabetes mellitus]]
|<nowiki>+</nowiki>
|<nowiki>-</nowiki>
|
* Acute-onset [[abdominal cramping]] 
|<nowiki>+</nowiki>
|<nowiki>+</nowiki>
| + (if [[necrosis]] and [[sepsis]])
|<nowiki>+</nowiki>
|<nowiki>+</nowiki>
|<nowiki>+</nowiki>
| + (if transmural [[necrosis]])
|<nowiki>-</nowiki>
|<nowiki>-</nowiki>
|<nowiki>-</nowiki>
|
* [[Hematochezia]]
|
* [[Leukocytosis]] (if [[necrosis]])
* [[Anemia]] (if [[Gastrointestinal perforation|perforation]] and [[bleeding]])
|<nowiki>-</nowiki>
|
|
|<nowiki>-</nowiki>
|<nowiki>-</nowiki>
|<nowiki>-</nowiki>
|<nowiki>+ (if bowel perforation)</nowiki>
|
* [[Bowel]] wall thickening
* Thumbprinting
* Pericolonic stranding with or without ascites.
* [[Halo sign|Double halo]] or target sign 
* [[Submucosal]] [[edema]] or [[hemorrhage]]
* Pneumatosis coli (if infarction)
|<nowiki>-</nowiki>
|}


==References==
==References==
{{Reflist|2}}
{{reflist|2}}


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Latest revision as of 15:18, 23 May 2018

Testicular torsion Microchapters

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Syed Hassan A. Kazmi BSc, MD [2]

Overview

Testicular torsion should be differentiated from other conditions presenting with lower abdominal pain, nausea and vomiting.

Differentiating Testicular Torsion From Other Diseases

Testicular torsion should be differentiated from other conditions presenting with lower abdominal pain , nausea and vomiting. The differentials include the following:[1][2][3][4][5][6][7][8][9][10][11][12][13][14][15][16][17][18][19][20][21][22][23][24][25][26][27][28][29][30][31][32][33][34]

Category Disease History Signs and Symptoms Physical Examination Laboratory abnormalities
Nausea/vomiting Hematuria Location of pain Fever Tachycardia Hypotension Hypertension Anorexia Constipation Rebound abdominal tenderness Urinary frequency/Urgency/Dysuria Costovetebral angle tenderness Pelvic Examination Rectal Examination Complete Blood Count (CBC) Urinalysis BUN Creatinine Stone analysis Urine Beta- hCG Abnormal Liver Function Tests (LFTs) Serum Amylase/Lipase Abdominal/Pelvic CT scan Serum Parathyroid hormone levels (PTH)

Renal Pathology

 Nephrolithiasis + + - + - - +/- - - + - - - - - - -
  • Non-contrast CT scan may show stone as radiolucency
 +/-
Pyelonephritis + + (microscopic) + + + - +/- - + + + - - - - -
  • Globaly decreased contrast uptake
  •  Foci from abscess pockets
 -
Renal infarct + + + + - + - - - - - - - - - -
Renal papillary necrosis - + (microscopic) + +/- - + - - - + - - - - - - - -
Renal cell carcinoma + + (microscopic) - - - + + +/- - - - - -
  • Anemia
 - - - -
  • Non-contrast CT:
  • Contrast-enhanced:
    • Homogenous (small lesions) to irregular (large lesions) contrast enhancement
 -
Uretral stricture - +/- - - - - - - - - + - - - - - - - - - - -

Prostate Pathology

 Prostatitis - + + + - - - - - + - - - - - - - - -
Prostatic cancer - + - - - - - + - - + - - - - - - - -

Testicular Pathology

 Testicular torsion + - - + - - +/- - - +/- - - - - - - - - - - -
Orchitis + - + + - - - - - +/- - - - - - - - - - -

Abdominal Pathology

 Cholecystitis + - + + - - + - - - - - - - - - - + +/-
  • Gallbladder distention
  • Wall thickening
  • Mucosal hyperenhancement,
  • Pericholecystic fat stranding or fluid
  • Gallstones
 -
Appendicitis + - + + - - + - + +/- - - -
  • Leukocytosis
 - - - - - - + (if perforation) -
Diverticulitis + - + + - - + + - - - - - - - - - - + (if perforation)
  • Colonic wall thickening (wall thickness is greater than 3 mm on the short axis of the lumen)
  • Pericolic fat stranding
 -
Abdominal aortic aneurysm - - - + + - - - + (if rupture) - - - - - - - - - - - -
  • Ultrasound more sensitive than CT scan
  • CT scan may accurately predict the aneurysmal size
  • Helical CT has faster scanning time (30 to 60 seconds) and the ability to obtain all images in one breath hold
 -
Portal vein thrombosis + - + + + - + - + (if bowel ischemia or infarction-secondary to extension of thrombus to superior mesenteric vein) - - - - - - - - + + (if bowel infarction, perforation)
  • On non-contrast CT:
    • Hyperdense thrombus
  • On contrast CT
    • Non-enhancing defect of bland thrombus
    • Tumor thrombus exhibits enhancement
Duodenal ulcer + - + + + - - - + (if perforation) - - - - - - - + (if bowel perforation) -
Ischemic colitis + - + + + (if necrosis and sepsis) + + + + (if transmural necrosis) - - - - - - - + (if bowel perforation) -

References

  1. ↑ Worcester EM, Coe FL (June 2008). "Nephrolithiasis". Prim. Care. 35 (2): 369–91, vii. doi:10.1016/j.pop.2008.01.005. PMC 2518455. PMID 18486720.
  2. ↑ Semins MJ, Matlaga BR (February 2010). "Medical evaluation and management of urolithiasis". Ther Adv Urol. 2 (1): 3–9. doi:10.1177/1756287210369121. PMC 3126068. PMID 21789078.
  3. ↑ Venkatesh L, Hanumegowda RK (June 2017). "Acute Pyelonephritis - Correlation of Clinical Parameter with Radiological Imaging Abnormalities". J Clin Diagn Res. 11 (6): TC15–TC18. doi:10.7860/JCDR/2017/27247.10033. PMC 5535453. PMID 28764263.
  4. ↑ Garin EH, Olavarria F, Araya C, Broussain M, Barrera C, Young L (July 2007). "Diagnostic significance of clinical and laboratory findings to localize site of urinary infection". Pediatr. Nephrol. 22 (7): 1002–6. doi:10.1007/s00467-007-0465-7. PMID 17375337.
  5. ↑ Lee DG, Jeon SH, Lee CH, Lee SJ, Kim JI, Chang SG (April 2009). "Acute pyelonephritis: clinical characteristics and the role of the surgical treatment". J. Korean Med. Sci. 24 (2): 296–301. doi:10.3346/jkms.2009.24.2.296. PMC 2672131. PMID 19399273.
  6. ↑ Saeed K (2012). "Renal infarction". Int J Nephrol Renovasc Dis. 5: 119–23. doi:10.2147/IJNRD.S33768. PMC 3437809. PMID 22969301.
  7. ↑ Mahamid M, Francis A, Abid A, Awawde M, Abu-Elhija O (2014). "Embolic renal infarction mimicking renal colic". Int J Nephrol Renovasc Dis. 7: 157–9. doi:10.2147/IJNRD.S59745. PMC 4011809. PMID 24812524.
  8. ↑ Korzets Z, Plotkin E, Bernheim J, Zissin R (October 2002). "The clinical spectrum of acute renal infarction". Isr. Med. Assoc. J. 4 (10): 781–4. PMID 12389340.
  9. ↑ Brix AE (2002). "Renal papillary necrosis". Toxicol Pathol. 30 (6): 672–4. doi:10.1080/01926230290166760. PMID 12512867.
  10. ↑ Eknoyan G, Qunibi WY, Grissom RT, Tuma SN, Ayus JC (March 1982). "Renal papillary necrosis: an update". Medicine (Baltimore). 61 (2): 55–73. PMID 7038374.
  11. ↑ Ng CS, Wood CG, Silverman PM, Tannir NM, Tamboli P, Sandler CM (October 2008). "Renal cell carcinoma: diagnosis, staging, and surveillance". AJR Am J Roentgenol. 191 (4): 1220–32. doi:10.2214/AJR.07.3568. PMID 18806169.
  12. ↑ Ares Valdés Y, Amador Sandoval B, Morales JC, Alonso Domínguez F, Carballo Velásquez L, Fragas Valdés R, Shou Rodríguez A (September 2004). "[The role of CT scan in the diagnosis of renal cell carcinoma]". Arch. Esp. Urol. (in Spanish; Castilian). 57 (7): 737–42. PMID 15536955.
  13. ↑ Leveridge MJ, Bostrom PJ, Koulouris G, Finelli A, Lawrentschuk N (June 2010). "Imaging renal cell carcinoma with ultrasonography, CT and MRI". Nat Rev Urol. 7 (6): 311–25. doi:10.1038/nrurol.2010.63. PMID 20479778.
  14. ↑ Tritschler S, Roosen A, Füllhase C, Stief CG, Rübben H (March 2013). "Urethral stricture: etiology, investigation and treatments". Dtsch Arztebl Int. 110 (13): 220–6. doi:10.3238/arztebl.2013.0220. PMC 3627163. PMID 23596502.
  15. ↑ Mundy AR, Andrich DE (January 2011). "Urethral strictures". BJU Int. 107 (1): 6–26. doi:10.1111/j.1464-410X.2010.09800.x. PMID 21176068.
  16. ↑ Maciejewski C, Rourke K (February 2015). "Imaging of urethral stricture disease". Transl Androl Urol. 4 (1): 2–9. doi:10.3978/j.issn.2223-4683.2015.02.03. PMC 4708283. PMID 26816803.
  17. ↑ Soper DE (August 2010). "Pelvic inflammatory disease". Obstet Gynecol. 116 (2 Pt 1): 419–28. doi:10.1097/AOG.0b013e3181e92c54. PMID 20664404.
  18. ↑ Paavonen J (October 1998). "Pelvic inflammatory disease. From diagnosis to prevention". Dermatol Clin. 16 (4): 747–56, xii. PMID 9891675.
  19. ↑ Lee MH, Moon MH, Sung CK, Woo H, Oh S (December 2014). "CT findings of acute pelvic inflammatory disease". Abdom Imaging. 39 (6): 1350–5. doi:10.1007/s00261-014-0158-1. PMID 24802548.
  20. ↑ Eggert J, Sundquist K, van Vuuren C, Fianu-Jonasson A (October 2006). "The clinical diagnosis of pelvic inflammatory disease--reuse of electronic medical record data from 189 patients visiting a Swedish university hospital emergency department". BMC Womens Health. 6: 16. doi:10.1186/1472-6874-6-16. PMC 1624808. PMID 17054801.
  21. ↑ Washington C, Carmichael JC (December 2012). "Management of ischemic colitis". Clin Colon Rectal Surg. 25 (4): 228–35. doi:10.1055/s-0032-1329534. PMC 3577613. PMID 24294125.
  22. ↑ Chawla YK, Bodh V (March 2015). "Portal vein thrombosis". J Clin Exp Hepatol. 5 (1): 22–40. doi:10.1016/j.jceh.2014.12.008. PMC 4415192. PMID 25941431.
  23. ↑ "Imaging of Abdominal Aortic Aneurysms - - American Family Physician".
  24. ↑ Aggarwal S, Qamar A, Sharma V, Sharma A (2011). "Abdominal aortic aneurysm: A comprehensive review". Exp Clin Cardiol. 16 (1): 11–5. PMC 3076160. PMID 21523201.
  25. ↑ Destigter KK, Keating DP (August 2009). "Imaging update: acute colonic diverticulitis". Clin Colon Rectal Surg. 22 (3): 147–55. doi:10.1055/s-0029-1236158. PMC 2780264. PMID 20676257.
  26. ↑ Hameed AM, Lam VW, Pleass HC (February 2015). "Significant elevations of serum lipase not caused by pancreatitis: a systematic review". HPB (Oxford). 17 (2): 99–112. doi:10.1111/hpb.12277. PMC 4299384. PMID 24888393.
  27. ↑ "Imaging for Suspected Appendicitis - - American Family Physician".
  28. ↑ "CT Findings of Acute Cholecystitis and Its Complications : American Journal of Roentgenology : Vol. 194, No. 6 (AJR)".
  29. ↑ "Epididymitis and Orchitis: An Overview - - American Family Physician".
  30. ↑ Jia JB, Houshyar R, Verma S, Uchio E, Lall C (January 2016). "Prostate cancer on computed tomography: A direct comparison with multi-parametric magnetic resonance imaging and tissue pathology". Eur J Radiol. 85 (1): 261–267. doi:10.1016/j.ejrad.2015.10.013. PMID 26526901.
  31. ↑ Bratt O, Lilja H (January 2015). "Serum markers in prostate cancer detection". Curr Opin Urol. 25 (1): 59–64. doi:10.1097/MOU.0000000000000128. PMC 4315142. PMID 25393274.
  32. ↑ "Prostate Cancer (Prostate Carcinoma): Symptoms - National Library of Medicine - PubMed Health".
  33. ↑ Eskicioğlu F, Özdemir AT, Turan GA, Gür EB, Kasap E, Genç M (November 2014). "The efficacy of complete blood count parameters in the diagnosis of tubal ectopic pregnancy". Ginekol. Pol. 85 (11): 823–7. PMID 25675798.
  34. ↑ Sivalingam VN, Duncan WC, Kirk E, Shephard LA, Horne AW (October 2011). "Diagnosis and management of ectopic pregnancy". J Fam Plann Reprod Health Care. 37 (4): 231–40. doi:10.1136/jfprhc-2011-0073. PMC 3213855. PMID 21727242.

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