Case of the Week — April Case #2: Scrotal Pain

42 y/o AAM presents to the ED with c/o scrotal pain for the past 4 days. He denies trauma or penile discharge and denies any recent sexual activity. He denies dysuria, F/C or abdominal pain. PMHx: none PSHx: none Meds: none Allergies: NKDA SocHx: denies tob, ETOH, or drugs PE: BP 130/85, P 126, R 16, T 99.8, Pox 99% (RA) GEN: WNWD, AAM, NAD CHEST: CTA B CV: tachy, RR, no M/R/G ABD: soft, NTND, +BS GU: L hemiscrotum edematous > R, no crepitus or ulceration, +TTP to L hemiscrotum, testicles with normal lie B and no TTP, no penile lesions or drainage, no inguinal LAD, DRE good tone, heme neg, prostate WNL Bedside US is performed and illustrates the following: What's the diagnosis? Thanks to Dr. Christina Gindele for submitting this case!