This is an x-ray chest PA view from a 26-year-old boy who presented with a left scrotal swelling for 6 months and low grade fever for 2 months. On examination, built and nourishment is below average, afebrile. No lymphadenopathy, clubbing. Mild pallor present. A swelling of size 2 X 3 cm is found in left scrotum arising from left spermatic cord, non tender with no local rise of temperature. Rest of the systems WNL. The case is open for discussion.

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I m not expert here .but just putting my input. Looks like B/l pneumonia with cavitation on left side.can it be septic emboli from sctotal abscess. But pt should be toxic and sick. 2) TB .ADV HEMOGRAM ESR RFT . I m not expert correct me if I m wrong

It's something else sir. Will let you know. Let others participate in the discussion.
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Dear readers and revered doctors, please note that the swelling was not exactly from the left testis but from the left spermatic cord. This was not a clear cut case clinically. Please explain that whether a mass arising from spermatic cord could also metastasise to lungs as we saw in this 26-year-old boy...!

wat abt usg scrotum n testis, abdomen, LDH, BHCG, AFP.. it ll help u get a baseline.
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This is a large canon ball appearence probably from ? Testicular tumor. Pls consider patient for high inguinal orchidectomy, do a detailed work up along with serum markers. s. LDH, b HCG, AFP, if affording whole body PET CT. Consider for chemotherapy

Hi all.. this would be a testicular gem cell tumour with pulmonary metastases USG scrotum to confirm diagnosis CECT thorax abdomen pelvis for staging tumour markers AFP, beta hcg, LDH High inguinal orchidectomy Then reassess with the histology for further treatment Repeat tumour markers after 4 weeks of surgery.. Will require chemotherapy with BEP regime..

Nice case Dr Arnab.. I suggest for a PET scan for staging before Starting treatment

Thank you sir for your compliment. It means a lot.
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Also counsel for infertility. his sperms should be banked. Chemo may make him infertile. His future wife will need his banked sperms to be mothet.

Germ cell Tumor with lung mets canon ball

Yes. U r right. I was thrilled IRONICALLY to get such an X ray in one of my patient. We used to read it in book Canon ball but never seen it before I came across this case.
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Very nice case. I m also thrilled to know that my MD knowledge is still intact very nice case

Of course, knowledge is such a thing nobody can snatch it from you.
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Is it Seminoma with lung mets

Seminoma with secondaries in lungs.

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