Testicular Torsion Differential Diagnoses

Updated: Oct 30, 2020
  • Author: Oreoluwa I Ogunyemi, MD; Chief Editor: Edward David Kim, MD, FACS  more...
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Diagnostic Considerations

Problems to be considered in the differential diagnosis of testicular torsion include the following:

  • Torsion of testicular or epididymal appendage
  • Epididymitis, orchitis, epididymo-orchitis
  • Hydrocele
  • Testis tumor
  • Idiopathic scrotal edema
  • Idiopathic testicular infarction
  • Traumatic rupture
  • Traumatic hematoma

Torsion of the testicular or epididymal appendage usually occurs in boys aged 7-12 years. Systemic symptoms are rare. Usually, localized tenderness occurs, but only in the upper pole of the testis. Occasionally, the blue dot sign (ie, a tender nodule with blue discoloration on the upper pole of the testis) is present in light-skinned boys.

Epididymitis, orchitis, and epididymo-orchitis conditions most commonly occur from the reflux of infected urine or from sexually acquired disease caused by gonococci and Chlamydia. Patients occasionally develop these conditions following excessive straining or lifting and the reflux of urine (chemical epididymitis).

These conditions may be secondary to an underlying congenital, acquired, structural, or urologic abnormality and are often accompanied by systemic signs and symptoms associated with urinary tract infection. Pyuria, bacteriuria, or leukocytosis is possible. A complete urologic evaluation (ie, renal sonography, urodynamic study) is necessary in prepubertal boys with acute epididymitis.

Hydrocele is usually associated with patent processus vaginalis. Painless swelling is usually present. Scrotal contents can be visualized with transillumination. Incarcerated hernia may be diagnosed by careful examination of the inguinal canal.

Testis tumor produces scrotal enlargement, only rarely accompanied by pain. The presentation is rarely acute.

In idiopathic scrotal edema, the scrotal skin is thickened, edematous, and often inflamed. The testis is not tender and is of normal size and position.

Differential Diagnoses