title: Hepatic Artery Rupture in a Young Man with Abdominal Pain and a Testicular Mass.
abstract: 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.
  
  
  METHODS
  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.
authors.affiliation: Department of Emergency Medicine, University of Alabama School of Medicine, Birmingham, Alabama.
authors.forename: Kevin S
authors.initials: KS
authors.lastname: Barlotta
authors.affiliation: Department of Emergency Medicine, University of Alabama School of Medicine, Birmingham, Alabama.
authors.forename: David
authors.initials: D
authors.lastname: Page
mesh_terms: D015746:Abdominal Pain / Q000209:etiology; D003937:Diagnosis, Differential; D004621:Embolization, Therapeutic / Q000379:methods; D004636:Emergency Service, Hospital / Q000458:organization & administration; D006499:Hepatic Artery / Q000002:abnormalities / Q000503:physiopathology*; D006801:Humans; D008113:Liver Neoplasms / Q000150:complications* / Q000175:diagnosis; D008297:Male; D012422:Rupture, Spontaneous / Q000150:complications*; D013736:Testicular Neoplasms / Q000175:diagnosis* / Q000209:etiology; D055815:Young Adult
keywords: abdominal pain; hepatic artery rupture; testicular cancer