UMEM Educational Pearls

Title: What's the Diagnosis? Case submitted and written by Dr. Zachary Dezman

Category: Visual Diagnosis

Posted: 3/12/2012 by Haney Mallemat, MD (Updated: 8/12/2014)
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Question

14 year-old male presents with right-sided testicular pain. What's the diagnosis?

Answer

Answer: Testicular torsion

Most common pediatric cause of testicular pain; Occurs in 1 in 4,000 males less than 25 years-old
Sudden and severe pain with diffuse testicular swelling and tenderness; right side is affected more than the left.
Most sensitive sign (90-100%) is absent or decreased cremaster reflex.
Diagnosis is made by ultrasound demonstrating an enlarged testicle, increased echogenicity, and little to no Doppler flow (as seen above) compared to a testicle with normal flow (see below)
Requires emergent urology consult for surgical detorsion and fixation of testis to prevent recurrence; testicular salvage rate is 90% within 6 hours of presentation as compared to 20% at 24-48 hours
Manual detorsion should be attempted if urology consult is delayed.

References

Shan Yin, MD, MPH, Jennifer L. Trainor, MD, Diagnosis and Management of Testicular Torsion, Torsion of the Appendix Testis, and Epididymitis, Clin Ped Emerg Med, 10:38-44, 2009

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