Torsion of testicular appendage: Difference between revisions

Latest revision as of 20:15, 4 June 2020

Not to be confused with Testicular Torsion

Background

Scrotal anatomy

Testicular anatomy

Appendix testis and appendix epididymis can torse
- Most common between 7-14yr
- No affect on fertility or surrounding structures

Clinical Features

Scrotal pain
- Milder and more gradual onset compared to testicular torsion
- Localized to one point of testicle
Physical exam
- Hard, tender 2-3mm nodule at upper pole of testicle
- Transillumination: ischemic appendage appears as blue dot (highly sp, not sn)

Differential Diagnosis

Testicular Diagnoses

Evaluation

Work-Up

Evaluation

Ultrasound
- Normal testicular flow, small hyperechoic region adjacent to testis

Management

Scrotal elevation
Ice
NSAIDS

Disposition

Discharge
Symptoms resolve in 7-10 days

References

Authors:

@@ Line 1: / Line 1: @@
+''Not to be confused with [[Testicular Torsion]]''
 ==Background==
-#scrotum has several vestigial appendages that can twist, become ischemic and cause pain
+[[File:Gray1144.png|thumb|Scrotal anatomy]]
-#appendix testis present in 92%, superior aspect of testicle between testis and epididymis
+[[File:Figure 28 01 03.jpg|thumb|Testicular anatomy]]
-#appendix epididymis present in 23%, tip of epididymis
+*Appendix testis and appendix epididymis can torse
-#common between 7-14 years old
+**Most common between 7-14yr
-#rivals testicular torsion in incidence
+**No affect on fertility or surrounding structures
-#after several days of ischemia due to torsion, the appendage will necrose and eventually get reabsorbed
-#no affect on fertility or surrounding structures
-==Diagnosis==
+==Clinical Features==
-#scrotal pain (milder and more gradual onset compared to testicular torsion) localized to one point of testicle
+*[[testicular Pain|Scrotal pain]]
-#exam shows hard, tender 2-3mm nodule at upper pole of testicle
+**Milder and more gradual onset compared to testicular torsion
-#transillumination, ischemic appendage appears as blue dot (highly specific, only 10% sensitive)
+**Localized to one point of testicle
-#UA negative
+*Physical exam
-#US shows normal to increased blood flow to involved appendage, symmetric testicles
+**Hard, tender 2-3mm nodule at upper pole of testicle
-##"Mickey Mouse" sign: juxtaposotion of testicle, enlarged appendix and epididymis
+**Transillumination: ischemic appendage appears as blue dot (highly sp, not sn)
-==Work-Up==
+==Differential Diagnosis==
-#UA
+{{Testicular DDX}}
-#testicular US
-==DDx==
+==Evaluation==
-#testicular torsion
+===Work-Up===
-#testicular mass
+*[[Urinalysis]]
-#epididymitis
+*[[testicular ultrasound|Ultrasound]]
-==Treatment==
+===Evaluation===
-#scrotal elevation
+*[[testicular torsion|Ultrasound]]
-#ice
+**Normal testicular flow, small hyperechoic region adjacent to testis
-#NSAIDS
+==Management==
+#Scrotal elevation
+#Ice
+#[[NSAIDS]]
 ==Disposition==
-#outpatient
+*Discharge
-#symptoms resolve in 7-10 days
+*Symptoms resolve in 7-10 days
-==Source==
+==See Also==
-Adapted from Rosen's
+*[[Testicular Torsion]]
+*[[Testicular Diagnoses]]
-[[Category:GU]]
+==References==
+<references/>
+[[Category:Urology]]
+[[Category:Pediatrics]]