Torsion of the Testicular Appendices and Epididymis Differential Diagnoses

1. Syed MK, Al Faqeeh AA, Othman A, et al. The spectrum of testicular pathologies upon scrotal exploration for acute scrotum: a retrospective analysis. Cureus. 2020 Oct 16. 12 (10):e10984. [QxMD MEDLINE Link].

2. Velasquez J, Boniface MP, Mohseni M. Acute scrotum pain. 2022 Jan. [QxMD MEDLINE Link]. [Full Text].

3. Deeg KH. Differential diagnosis of acute scrotum in childhood and adolescence with high-resolution duplex sonography. Ultraschall Med. 2021 Feb. 42 (1):10-38. [QxMD MEDLINE Link].

4. Fabiani A, Calabrese M, Filosa A, et al. Explorative surgery for acute scrotal pain: the importance of patient age, side affected, time to surgery and surgeon. Arch Ital Urol Androl. 2016 Oct 5. 88 (3):189-94. [QxMD MEDLINE Link].

5. Tanaka K, Ogasawara Y, Nikai K, et al. Acute scrotum and testicular torsion in children: a retrospective study in a single institution. J Pediatr Urol. 2020 Feb. 16 (1):55-60. [QxMD MEDLINE Link].

6. Sweet DE, Feldman MK, Remer EM. Imaging of the acute scrotum: keys to a rapid diagnosis of acute scrotal disorders. Abdom Radiol (NY). 2020 Jul. 45 (7):2063-81. [QxMD MEDLINE Link].

7. Saxena AK, Castellani C, Ruttenstock EM, et al. Testicular torsion: a 15-year single center clinical and histological analysis. Acta Paediatr. 2012 Jul. 101 (7):e282-6. [QxMD MEDLINE Link].

8. Campo I, Valentino M, Sidhu PS, et al. Nonscrotal causes of acute scrotum. J Ultrasound Med. 2021 Mar. 40 (3):597-605. [QxMD MEDLINE Link].

9. Nason GJ, Tareen F, McLoughlin D, et al. Scrotal exploration for acute scrotal pain: a 10-year experience in two tertiary referral paediatric units. Scand J Urol. 2013 Oct. 47 (5):418-22. [QxMD MEDLINE Link].

10. Even L, Abbo O, Le Mandat A, et al. [Testicular torsion in children: factors influencing delayed treatment and orchiectomy rate]. Arch Pediatr. 2013 Apr. 20 (4):364-8. [QxMD MEDLINE Link].

11. Rakha E, Puls F, Saidul I, et al. Torsion of the testicular appendix: importance of associated acute inflammation. J Clin Pathol. 2006 Aug. 59 (8):831-4. [QxMD MEDLINE Link].

12. Boettcher M, Bergholz R, Krebs TF, et al. Clinical predictors of testicular torsion in children. Urology. 2012 Mar. 79 (3):670-4. [QxMD MEDLINE Link].

13. Krishnan A, Rich MA, Swana HS. Torsion of the appendix testis in a neonate. Case Rep Urol. 2016. 2016:9183196. [QxMD MEDLINE Link].

14. Messina M, Fusi G, Ferrara F, et al. A rare cause of acute scrotum in a child: torsion of an epididymal cyst. Case report and review of the literature. Pediatr Med Chir. 2019 Jun 21. 41 (1):[QxMD MEDLINE Link].

15. Alqasem S, Alhamdan A, Alhefzi A, et al. Acute scrotum in elderly; is it torsion !. Urol Case Rep. 2020 Jan. 28:101032. [QxMD MEDLINE Link].

16. Lev M, Ramon J, Mor Y, et al. Sonographic appearances of torsion of the appendix testis and appendix epididymis in children. J Clin Ultrasound. 2015 Oct. 43 (8):485-9. [QxMD MEDLINE Link].

17. Karmazyn B, Steinberg R, Kornreich L. Clinical and sonographic criteria of acute scrotum in children: a retrospective study of 172 boys. Pediatr Radiol. 2005 Mar. 35(3):302-10. [QxMD MEDLINE Link].

18. Laimer G, Müller R, Radmayr C, et al. Multiparametric ultrasound in torsion of the testicular appendages: a reliable diagnostic tool?. Med Ultrason. 2021 Sep 11. [QxMD MEDLINE Link].

19. Boettcher M, Bergholz R, Krebs TF, et al. Differentiation of epididymitis and appendix testis torsion by clinical and ultrasound signs in children. Urology. 2013 Oct. 82 (4):899-904. [QxMD MEDLINE Link].

20. Aydogdu O, Burgu B, Gocun PU, et al. Near infrared spectroscopy to diagnose experimental testicular torsion: comparison with Doppler ultrasound and immunohistochemical correlation of tissue oxygenation and viability. J Urol. 2012 Feb. 187 (2):744-50. [QxMD MEDLINE Link].

21. Galina P, Dermentzoglou V, Baltogiannis N, et al. Sonographic appearances of the epididymis in boys with acute testicular torsion but preserved testicular blood flow on color Doppler. Pediatr Radiol. 2015 Oct. 45 (11):1661-71. [QxMD MEDLINE Link].

22. Remer EM, Casalino DD, Arellano RS, et al. ACR Appropriateness Criteria® acute onset of scrotal pain - without trauma, without antecedent mass. Ultrasound Q. 2012 Mar. 28 (1):47-51. [QxMD MEDLINE Link].

23. Pepe P, Panella P, Pennisi M, et al. Does color Doppler sonography improve the clinical assessment of patients with acute scrotum?. Eur J Radiol. 2006 Oct. 60 (1):120-4. [QxMD MEDLINE Link].

24. Melloul M, Paz A, Lask D, et al. The pattern of radionuclide scrotal scan in torsion of testicular appendages. Eur J Nucl Med. 1996 Aug. 23(8):967-70. [QxMD MEDLINE Link].

25. Sazgar M, Montazer SH, Hosseininejad SM, et al. Clinical predictors of testicular torsion in patients with acute scrotum; a cross-sectional study. Arch Acad Emerg Med. 2022. 10 (1):e9. [QxMD MEDLINE Link].

26. Barloon TJ, Weissman AM, Kahn D. Diagnostic imaging of patients with acute scrotal pain. Am Fam Physician. 1996 Apr. 53(5):1734-50. [QxMD MEDLINE Link].

27. Fisher R, Walker J. The acute paediatric scrotum. Br J Hosp Med. 1994 Mar 16-Apr 5. 51(6):290-2. [QxMD MEDLINE Link].

28. Holland JM, Graham JB, Ignatoff JM. Conservative management of twisted testicular appendages. J Urol. 1981 Feb. 125(2):213-4. [QxMD MEDLINE Link].

29. Hormann M, Balassy C, Philipp MO, et al. Imaging of the scrotum in children. Eur Radiol. 2004 Jun. 14 (6):974-83. [QxMD MEDLINE Link].

30. Johnson KA, Dewbury KC. Ultrasound imaging of the appendix testis and appendix epididymis. Clin Radiol. 1996 May. 51(5):335-7. [QxMD MEDLINE Link].

31. Kadish HA, Bolte RG. A retrospective review of pediatric patients with epididymitis, testicular torsion, and torsion of testicular appendages. Pediatrics. 1998 Jul. 102(1 Pt 1):73-6. [QxMD MEDLINE Link].

32. Kogan SJ, Hadziselmovic F, Howards SS. Pediatric andrology: congenital and acquired scrotal abnormalities. Adult and Pediatric Urology. 4th ed. 2002. Vol 3: 2570-81.

33. Lewis AG, Bukowski TP, Jarvis PD, et al. Evaluation of acute scrotum in the emergency department. J Pediatr Surg. 1995 Feb. 30(2):277-81; discussion 281-2. [QxMD MEDLINE Link].

34. McAndrew HF, Pemberton R, Kikiros CS. The incidence and investigation of acute scrotal problems in children. Peditric Surg Int. 2002 Sept. 18:435-7. [QxMD MEDLINE Link].

35. Rabinowitz R, Hulbert WC Jr. Acute scrotal swelling. Urol Clin North Am. 1995 Feb. 22(1):101-5. [QxMD MEDLINE Link].

36. Ravichandran S, Blades RA, Watson ME. Torsion of the epididymis: a rare cause of acute scrotum. Int J Urol. 2003 Oct. 10(10):556-7. [QxMD MEDLINE Link].

37. Sahni D, Jit I, Joshi K, et al. Incidence and structure of the appendices of the testis and epididymis. J Anat. 1996 Oct. 189 ( Pt 2):341-8. [QxMD MEDLINE Link].

38. Siegel MJ. The acute scrotum. Radiol Clin North Am. 1997 Jul. 35(4):959-76. [QxMD MEDLINE Link].

39. Strauss S, Faingold R, Manor H. Torsion of the testicular appendages: sonographic appearance. J Ultrasound Med. 1997 Mar. 16(3):189-92; quiz 193-4. [QxMD MEDLINE Link].

40. Watkin NA, Reiger NA, Moisey CU. Is the conservative management of the acute scrotum justified on clinical grounds?. Br J Urol. 1996 Oct. 78(4):623-7. [QxMD MEDLINE Link].

41. Williamson RC. Torsion of the testis and allied conditions. Br J Surg. 1976 Jun. 63(6):465-76. [QxMD MEDLINE Link].

42. Yazbeck S, Patriquin HB. Accuracy of Doppler sonography in the evaluation of acute conditions of the scrotum in children. J Pediatr Surg. 1994 Sep. 29(9):1270-2. [QxMD MEDLINE Link].

Jason S Chang, MD Clinical Instructor, Department of Emergency Medicine, University of Pittsburgh Medical Center

Jason S Chang, MD is a member of the following medical societies: American College of Emergency Physicians, American Medical Association, Society for Academic Emergency Medicine, Emergency Medicine Residents' Association

Disclosure: Nothing to disclose.

Francisco Talavera, PharmD, PhD Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Received salary from Medscape for employment. for: Medscape.

Richard H Sinert, DO Professor of Emergency Medicine, Clinical Assistant Professor of Medicine, Research Director, State University of New York College of Medicine; Consulting Staff, Vice-Chair in Charge of Research, Department of Emergency Medicine, Kings County Hospital Center

Richard H Sinert, DO is a member of the following medical societies: American College of Physicians, Society for Academic Emergency Medicine

Disclosure: Nothing to disclose.

Erik D Schraga, MD Staff Physician, Department of Emergency Medicine, Mills-Peninsula Emergency Medical Associates

Disclosure: Nothing to disclose.

Theodore J Gaeta, DO, MPH, FACEP Clinical Associate Professor, Department of Emergency Medicine, Weill Cornell Medical College; Vice Chairman and Program Director of Emergency Medicine Residency Program, Department of Emergency Medicine, New York Methodist Hospital; Academic Chair, Adjunct Professor, Department of Emergency Medicine, St George's University School of Medicine

Theodore J Gaeta, DO, MPH, FACEP is a member of the following medical societies: American College of Emergency Physicians, New York Academy of Medicine, Society for Academic Emergency Medicine, Council of Residency Directors in Emergency Medicine, Clerkship Directors in Emergency Medicine, Alliance for Clinical Education

Disclosure: Nothing to disclose.

The authors and editors of Medscape Reference gratefully acknowledge the contributions of previous authors, Sean O Henderson, MD, and Gregory Alfred, MD, to the development and writing of this article.

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