Right sided testicular pain as the sole presenting symptom of an abdominal aortic aneurysm: A case report.

Introduction and importance: This case highlights the rare presentation of testicular pain in a patient with a symptomatic abdominal aortic aneurysm (sAAA). Atypical presentations provide diagnostic challenges for timely diagnosis. This case report aims to show the importance of considering sAAA in the differential diagnosis of testicular pain, especially in older patients with known cardiovascular risk factors. Prompt diagnosis and early intervention are critical to improving outcomes in cases of ruptured abdominal aortic aneurysms (rAAA). Presentation of case: A 62-year-old male with a medical history of hypertension, hyperlipidaemia, and prostate cancer presented to the emergency department with sudden-onset right-sided testicular pain. On initial examination, the patient had a soft abdomen with mild lower abdominal tenderness and Point of Care Ultrasound (POCUS) identified a 9.1 cm abdominal aortic aneurysm. A 9.4 cm infrarenal sAAA was subsequently confirmed on a Computed Tomography (CT) Aorta. The patient initially remained hemodynamically stable, but shortly afterwards developed hypotension, confusion, and worsening pain. A repeat CTA revealed retroperitoneal haemorrhage, indicating a rupture of the aneurysm. The patient underwent an emergency open aneurysm repair. Clinical discussion: Abdominal aortic aneurysms (rAAAs) often present atypically, leading to diagnostic delays. A large meta-analysis has shown misdiagnosis rates as high as 42 % [1], commonly mistaken for urological or gastrointestinal conditions. This case demonstrates the importance of early recognition of atypical symptoms, such as isolated testicular pain, to avoid misdiagnosis and enable timely intervention. The referred pain was likely mediated via the genitofemoral nerve, irritated by the aneurysm and adjacent hematoma. Conclusion: Given the high mortality associated with rAAA, early recognition of atypical symptoms, including testicular pain, is crucial. Time to diagnosis and prompt management remain crucial determinants of outcomes in rAAA [2]. This case highlights the importance of maintaining a broad differential diagnosis in patients with testicular pain.