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What’s the diagnosis?

This young man presented with left loin pain. A non-contrast CT was performed to exclude ureteric stone.

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4 replies
  1. Dr. Jai Prakash
    Dr. Jai Prakash says:

    On the basis of non contrast CT it is difficult to say either benign or malignant retro-peritoneal mass. However rare but it may be retro-peritoneal lipoma or fibrosis also.

  2. Hamid Abboudi
    Hamid Abboudi says:

    As testicular cancer is high on the differential diagnosis list, I would also include a testicular US to the investigation list. This will confirm the presence of a testicular tumour and as well as lateralise the pathology so that an orchidectomy can be planned.

    • Matthew Bultitude
      Matthew Bultitude says:

      Learning points:
      1) Loin pain does not equal stone
      2) Always examine scrotum with all abdominal pain.

      Agree about testicular USS. May well have primary chemo rather than orchidectomy I guess depending on findings/ markers/ other staging, especially as presentation with loin pain.

  3. Mr. Ananda Kumar Dhanasekaran
    Mr. Ananda Kumar Dhanasekaran says:

    CT shows reteroperitoneal mass lesion.
    Likely diagnosis is reteroperitoneal metastasis from testicular malignancy.

    Testicular tumor markers, contrast ct of chest and abdomen with pelvis, ultrasound testes.
    Most important is good abdomen and genital examination.

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