Torsion of testicular appendage

Background

1. scrotum has several vestigial appendages that can twist, become ischemic and cause pain
2. appendix testis present in 92%, superior aspect of testicle between testis and epididymis
3. appendix epididymis present in 23%, tip of epididymis
4. common between 7-14 years old
5. rivals testicular torsion in incidence
6. after several days of ischemia due to torsion, the appendage will necrose and eventually get reabsorbed
7. no affect on fertility or surrounding structures

Diagnosis

1. scrotal pain (milder and more gradual onset compared to testicular torsion) localized to one point of testicle
2. exam shows hard, tender 2-3mm nodule at upper pole of testicle
3. transillumination, ischemic appendage appears as blue dot (highly specific, only 10% sensitive)
4. UA negative
5. US shows normal to increased blood flow to involved appendage, symmetric testicles
   1. "Mickey Mouse" sign: juxtaposotion of testicle, enlarged appendix and epididymis

Work-Up

1. UA
2. testicular US

DDx

1. testicular torsion
2. testicular mass
3. epididymitis

Treatment

1. scrotal elevation
2. ice
3. NSAIDS

Disposition

1. outpatient
2. symptoms resolve in 7-10 days

Source

Adapted from Rosen's