We present two cases of young men with spontaneous nontraumatic testicular pain. While the differential diagnosis for scrotal or testicular pain can include less urgent causes, such as epididymitis, hydrocele, referred pain, idiopathic scrotal edema, and inguinal hernia, for example, the most feared etiology for acute scrotal pain is testicular torsion. The fact that a testicle can torse and detorse is also a confounding factor. In this case review, we explore factors affecting the timely diagnosis, management, and outcomes of acute testicular pain. Prompt diagnosis is imperative in order to salvage a torsed testicle.

The authors present a case of symptomatic May-Thurner syndrome in the absence of a deep venous thrombosis. This is an unusual case, as most cases are diagnosed with a deep venous thrombosis as the underlying finding. The clinical presentation and suggested diagnostic workup are discussed. A key point is the need to consider this frequently under-diagnosed condition. Optimal management is often with a stent, but if not diagnosed, the patient can develop unnecessary clot burden, be placed on lifelong anticoagulation, or both.

Altered mental status is a common emergency department presentation. It has a broad differential and can be particularly challenging when the patient is unable to give a history and collateral information is not immediately available. The authors present a case of altered mental status initially brought in as a stroke alert but later discovered to be intentional organophosphate ingestion. Although organophosphate poisoning is relatively rare in the United States, it should be considered in patients with altered mental status with miosis who are unresponsive to naloxone, especially in the setting of bradycardia or copious secretions.