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==
+[[File:Gray1144.png|thumb|Scrotal anatomy]]
+[[File:Figure 28 01 03.jpg|thumb|Testicular anatomy]]
+*Appendix testis and appendix epididymis can torse
+**Most common between 7-14yr
+**No affect on fertility or surrounding structures
+==Clinical Features==
+*[[testicular Pain|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)
--scrotum has several vestigial appendages that can twist, become ischemic and cause pain
+==Differential Diagnosis==
+{{Testicular DDX}}
--appendix testis present in 92%, superior aspect of testicle between testis and epididymis
+==Evaluation==
+===Work-Up===
+*[[Urinalysis]]
+*[[testicular ultrasound|Ultrasound]]
--appendix epididymis present in 23%, tip of epididymis
+===Evaluation===
+*[[testicular torsion|Ultrasound]]
+**Normal testicular flow, small hyperechoic region adjacent to testis
--common between 7-14 years old
+==Management==
+#Scrotal elevation
--rivals testicular torsion in incidence
+#Ice
+#[[NSAIDS]]
--after several days of ischemia due to torsion, the appendage will necrose and eventually get reabsorbed
--no affect on fertility or surrounding structures
-==Diagnosis==
--scrotal pain (milder and more gradual onset compared to testicular torsion) localized to one point of testicle
--exam shows hard, tender 2-3mm nodule at upper pole of testicle
--transillumination, ischemic appendage appears as blue dot (highly specific, only 10% sensitive)
--UA negative
--US shows normal to increased blood flow to involved appendage, symmetric testicles
-     -"Mickey Mouse" sign: juxtaposotion of testicle, enlarged appendix and epididymis
-==Work-Up==
--UA
--testicular US
-==DDx==
--testicular torsion
--testicular mass
--epididymitis
-==Treatment==
--scrotal elevation
--ice
--NSAIDS
 ==Disposition==
+*Discharge
+*Symptoms resolve in 7-10 days
+==See Also==
+*[[Testicular Torsion]]
+*[[Testicular Diagnoses]]
--outpatient
+==References==
+<references/>
--symptoms resolve in 7-10 days
+[[Category:Urology]]
+[[Category:Pediatrics]]
-==Source==
-Adapted from Rosens
-[[Category:GU]]