Testicular torsion | Torsion of appendage | Acute epididymitis | |
Historical features | |||
Peak incidence | Perinatal and puberty | Prepubertal | <2 years and postpubertal |
Onset of pain | Usually sudden | Usually sudden | Usually gradual |
Duration of pain | Usually <12 hours | Usually >12 hours | Usually >24 hours |
Previous painful episodes | Typical | Unusual | Uncommon unless prior history of epididymitis |
Nausea and vomiting | Common | Uncommon | Uncommon |
Fever | Unusual | Unusual | Common |
History of trauma | Occasional | Unusual | Unusual |
Dysuria or discharge | Rare | Rare | Common |
Physical findings | |||
Suggestive findings | Horizontal lie, high-riding testicle | Palpable nodule "blue dot" | None |
Cremasteric reflex | Usually absent | Usually present | Usually present |
Tenderness | Testicular initially, then diffuse | Appendage initially, then testis | Epididymis initially, then diffuse |
Scrotal erythema or edema | Common >12 hours | Common >12 hours | Common >12 hours |
Laboratory tests | |||
Pyuria | Unusual | Unusual | Common |
Positive smear, culture, rapid molecular testing, or NAAT for STD | No | No | Often |
Leukocytosis | Common | Uncommon | Common |
Imaging | |||
Color Doppler ultrasound* | Decreased blood flow, spermatic cord knot | Normal or increased | Normal or increased |
NAAT: nucleic acid amplification testing; STD: sexually transmitted disease.
* When clinical findings are strongly suggestive for testicular torsion, promptly consult a surgeon with pediatric urologic expertise to evaluate the patient before ordering imaging. If clinical findings are equivocal for testicular torsion, then obtain color Doppler ultrasound to assess blood flow to the testicles.Do you want to add Medilib to your home screen?