Torsion of testicular appendage

Background

-scrotum has several vestigial appendages that can twist, become ischemic and cause pain

-appendix testis present in 92%, superior aspect of testicle between testis and epididymis

-appendix epididymis present in 23%, tip of epididymis

-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

-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

-outpatient

-symptoms resolve in 7-10 days

Source

Adapted from Rosens