Fact-sheet: Torsion of the testicular appendage
Updated on 04/19/2018 at 6:46 PM
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Definition
Torsion of the testicular appendage, a paraepididymal supratesticular appendage of embryonic remnant origin, inconstant, often bilateral
Clinical features
Sudden testicular pain.
Painful nodular induration a few millimeters in size at the upper pole of the testis, sometimes bluish.
Large erythematous hemiscrotum.
Possible absence of the cremasteric reflex.
No signs of infection.
Laboratory findings
No inflammatory syndrome
Ultrasound
Hyperechoic or hypoechoic supratesticular nodular lesion a few millimeters in size, avascular on color Doppler.
No enhancement on contrast-enhanced ultrasound.
Associated findings: enlargement of the epididymal head and scrotal wall thickening. Epididymal and scrotal hyperemia on color Doppler. Reactive hydrocele.
Management
No surgical treatment.
Medical treatment with NSAIDs
Differential diagnosis
1/ Spermatic cord torsion
Population: 2 peaks of incidence (newborn and prepubertal period).
Diagnosis is primarily clinical. Ultrasound should not delay therapeutic management (4 to 6-hour window before testicular necrosis).
Ultrasound findings:
-The only reliable sign: the spermatic cord whorl (snail shell-shaped, paratesticular lesion measuring more than 11 mm, whereas a normal cord measures less than 5 mm)
-Doppler findings: sometimes misleading. Decreased parenchymal vascularity compared with the contralateral side, sometimes difficult to demonstrate in the early phase, especially in children.
- Late morphological findings: heterogeneous testicular echotexture, correlated with necrosis.
2/Orchitis & epididymitis:
Clinical and biological infectious syndrome.
Enlarged testis and epididymis with hyperemia on Doppler.
Enlarged, hyperemic epididymis
3/ Strangulated inguinoscrotal hernia
4/ Testicular tumor with acute presentation
5/ Acute scrotal edema: Idiopathic scrotal inflammation, often extending to the perineum, mildly or non-painful