Pediatric Emergency Critical Care and Ultrasound by Unknown

Author:Unknown
Language: eng
Format: epub
Publisher: Cambridge University Press
Published: 2014-03-30T16:00:00+00:00

Figure 12.8 Neonatal testicular torsion. (a) The Doppler flow of the left testicle of a newborn, with absent blood flow in the intratesticular arteries and severely decreased venous blood flow. (b) Finding of testicular infarction at surgery with a black testicle and infarcted epididymis. Images courtesy of Mahmoud Elbarbary, MD MSc PhD.

Figure 12.9 Testicular torsion. Heterogeneous-appearing testis, without blood flow, using color Doppler.

Torsion of the appendix testes

The normal scrotum has several vestigial appendages that can also twist and become ischemic, resulting in acute scrotal pain. The most common is torsion of the appendix testis, which occurs between 7 and 14 years of age. The appendix testis is a small structure that is a remnant of the paramesonephric duct. It is located on the superior aspect of the testicle, between the testis and the epididymis. With torsion of the appendix testes, there is ischemia and eventually necrosis. However, torsion of the appendix testes has not been shown to affect fertility. It may however, lead to inflammation of the overlying epididymis head, leading to epididymitis in prepubertal boys. On physical examination, torsion of the appendix testes often leads to a hard, tender, 2–3 mm nodule at the superior aspect of the testicle. The cremasteric reflex is often intact. One may occasionally appreciate the “blue dot” sign, which refers to the blue appearance of the ischemic or black appendix with transillumination of the scrotum. This, however, is not a reliable indicator of a torsed appendix testis.

Ultrasound examination may reveal an avascular hypoechoic mass next to a normally perfused testis and surrounded by an area of increased color flow. However, depending on the location of the appendix testis, it may not be visualized on ultrasound unless it is outlined by fluid from a hydrocele.

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