Imaging tests are usually not helpful, but can be done to rule out differential diagnoses, such as epididymitis, tense hydrocele, inguinoscrotal hernia, or torsion of testicular appendage if testicular torsion is not highly suspected.
Visits to the emergency department primarily comprise individuals presenting with scrotal pain due to testicular torsion or torsion of the testicular appendages.
4 Torsion of testicular appendage
was 29% and epididymo-orchitis was 15%, remaining 16% consisted of other scrotal condition.
Other possible causes of an acute scrotum include torsion of a testicular appendage
, epididymoorchitis, and incarcerated hernia.
Common pediatric scrotal diseases seen in the ED include testicular torsion, testicular appendage torsion, epididymitis, orchitis, hernia, hematocele and abscess.
In a child with an acute scrotum, torsion of a testicular appendage represents the most common cause of scrotal pain.
A retrospective review of pediatric patients with epididymitis, testicular torsion, and torsion of testicular appendages
In addition to the testis, testicular appendages
can also undergo torsion, typically occurring in patients 7-14 years of age.
1-3) Four testicular appendages, remnants of embryonic ducts, include the appendix testis, appendix epididymis, vas aberrans, and the paradidymis; 92% of males have an appendix testis, and 34% have an appendix epididymis.
Torsion of the testicular appendages occurs less frequently than does testicular torsion (6:1) but can be as painful.