Torsion of testicular appendage: Difference between revisions

Revision as of 01:01, 25 June 2011

Background

Appendix testis and appendix epididymis can torse
- Most common between 7-14 years old
- 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
Physical exam
- Hard, tender 2-3mm nodule at upper pole of testicle
- Transillumination: ischemic appendage appears as blue dot (highly sp, not sn)
Ultrasound
- Normal testicular flow, small hyperechoic region adjacent to testis

Work-Up

UA
Ultrasond

DDx

Testicular torsion
Testicular mass
Epididymitis

Treatment

Scrotal elevation
Ice
NSAIDS

Disposition

Discharge
Symptoms resolve in 7-10 days

Source

Tintinalli, Rosen's

Authors:

@@ Line 1: / Line 1: @@
 ==Background==
-#scrotum has several vestigial appendages that can twist, become ischemic and cause pain
+*Appendix testis and appendix epididymis can torse
-#appendix testis present in 92%, superior aspect of testicle between testis and epididymis
+**Most common between 7-14 years old
-#appendix epididymis present in 23%, tip of epididymis
+**No affect on fertility or surrounding structures
-#common between 7-14 years old
-#rivals testicular torsion in incidence
-#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
+*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)
+*Ultrasound
+**Normal testicular flow, small hyperechoic region adjacent to testis
 ==Work-Up==
-#UA
+*UA
-#testicular US
+*Ultrasond
 ==DDx==
-#testicular torsion
+#Testicular torsion
-#testicular mass
+#Testicular mass
-#epididymitis
+#Epididymitis
 ==Treatment==
-#scrotal elevation
+#Scrotal elevation
-#ice
+#Ice
 #NSAIDS
 ==Disposition==
-#outpatient
+#Discharge
-#symptoms resolve in 7-10 days
+#Symptoms resolve in 7-10 days
+==See Also==
+[[Testicular Torsion]]
 ==Source==
-Adapted from Rosen's
+Tintinalli, Rosen's
 [[Category:GU]]