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Torsion of Testicular Appendage

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1. Torsion of Testicular Appendage

Torsion of Testicular Appendage Torsion of Testicular Appendage Toggle navigation Brain Head & Neck Chest Endocrine Abdomen Musculoskeletal Skin Infectious Disease Hematology & Oncology Cohorts Diagnostics Emergency Findings Procedures Prevention & Management Pharmacy Resuscitation Trauma Emergency Procedures Ultrasound Cardiovascular Emergencies Lung Emergencies Infectious Disease Pediatrics Neurologic Emergencies Skin Exposure Miscellaneous Abuse Cancer Administration 4 Torsion of Testicular (...) Appendage Torsion of Testicular Appendage Aka: Torsion of Testicular Appendage , Torsion of Appendix Testes From Related Chapters II. Epidemiology Most common in boys under age 3-5 years up to age 12 years old III. Differential Diagnosis IV. Symptoms Insidious onset of unilateral Similar characteristics of without the systemic symptoms (e.g. rare or ) V. Signs Tiny, focally tender, palpable mass at upper pole "Blue dot" sign on scrotal skin early in course Testicular Inflammation and are late findings

2018 FP Notebook

2. Suppurative appendicitis presenting as acute scrotum confounded by a testicular appendage (PubMed)

Suppurative appendicitis presenting as acute scrotum confounded by a testicular appendage Patients presenting with testicular pain and swelling mandate an urgent urology review and scrotal exploration to prevent testicle loss due to torsion. Other pathology masquerading as torsion is extremely rare but can occur. We present one such case. A 14-year-old male presented with a 1-day history of right testicular swelling and tenderness. He was apyrexial and denied any other symptoms. Blood tests (...) demonstrated raised inflammatory markers. He had lower left-sided abdominal tenderness with a swollen, erythematous right hemiscrotum. During an urgent scrotal exploration for testicular torsion, a purulent hydrocele with a patent process vaginalis was noted, but no torsion. Post-operative abdominal pain mandated a general surgical review and subsequent appendicectomy. The patient made a full recovery. Acute suppurative appendicitis presenting as a urological emergency is extremely rare. To make a correct

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2016 Journal of surgical case reports

3. Torsion of Testicular Appendage

Torsion of Testicular Appendage Torsion of Testicular Appendage Toggle navigation Brain Head & Neck Chest Endocrine Abdomen Musculoskeletal Skin Infectious Disease Hematology & Oncology Cohorts Diagnostics Emergency Findings Procedures Prevention & Management Pharmacy Resuscitation Trauma Emergency Procedures Ultrasound Cardiovascular Emergencies Lung Emergencies Infectious Disease Pediatrics Neurologic Emergencies Skin Exposure Miscellaneous Abuse Cancer Administration 4 Torsion of Testicular (...) Appendage Torsion of Testicular Appendage Aka: Torsion of Testicular Appendage , Torsion of Appendix Testes From Related Chapters II. Epidemiology Most common in boys under age 3-5 years up to age 12 years old III. Differential Diagnosis IV. Symptoms Insidious onset of unilateral Similar characteristics of without the systemic symptoms (e.g. rare or ) V. Signs Tiny, focally tender, palpable mass at upper pole "Blue dot" sign on scrotal skin early in course Testicular Inflammation and are late findings

2015 FP Notebook

4. Two Unusual Cases of Torsion of Testicular Appendages (PubMed)

Two Unusual Cases of Torsion of Testicular Appendages 13758757 1998 11 01 2018 11 30 0007-1447 1 5242 1961 Jun 24 British medical journal Br Med J Two unusual cases of torsion of testicular appendages. 1809-10 LANG J R JR eng Journal Article England Br Med J 0372673 0007-1447 OM Cryptorchidism complications Disease Epididymis Extremities Humans Male CRYPTORCHISM/complications EPIDIDYMIS/diseases 1961 6 24 1961 6 24 0 1 1961 6 24 0 0 ppublish 13758757 PMC1954391 Wis Med J. 1951 Jul;50(7):670-2

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1961 British medical journal

5. Testicular Torsion

Testicular Torsion Testicular Torsion Imaging: Overview, Magnetic Resonance Imaging, Ultrasonography Edition: No Results No Results Please confirm that you would like to log out of Medscape. If you log out, you will be required to enter your username and password the next time you visit. https://profreg.medscape.com/px/getpracticeprofile.do?method=getProfessionalProfile&urlCache=aHR0cHM6Ly9lbWVkaWNpbmUubWVkc2NhcGUuY29tL2FydGljbGUvMzgxMjA0LW92ZXJ2aWV3 processing > Testicular Torsion Imaging (...) Updated: Aug 12, 2015 Author: David Paushter, MD; Chief Editor: Eugene C Lin, MD Share Email Print Feedback Close Sections Sections Testicular Torsion Imaging Overview Overview Testicular torsion, also termed torsion of the spermatic cord, is a relatively common and potentially devastating acute condition due to obstruction of the arterial blood supply to the testis. [ ] Fortunately, this entity is relatively well known, and it usually occurs with enough discomfort to lead to its diagnosis

2014 eMedicine Radiology

6. Detection of normal intratesticular perfusion using colour-coded duplex sonography obviates the need for scrotal exploration in patients with clinical suspicion of testicular torsion. (PubMed)

, specificity, and positive and negative predictive values of color coded duplex sonography for diagnosing testicular torsion were calculated based on preoperative ultrasound findings, and compared to the final diagnosis after surgical exploration.Testicular torsion was the most common cause of impaired intratesticular blood flow (119 cases, 50.4%), followed by torsion of the testicular appendages (82, 34.8%), epididymo-orchitis (18, 7.6%) and various other conditions (17, 7.2%). The sensitivity (...) Detection of normal intratesticular perfusion using colour-coded duplex sonography obviates the need for scrotal exploration in patients with clinical suspicion of testicular torsion. Although color coded duplex sonography is useful for visualizing testicular perfusion in patients with clinical suspicion of testicular torsion, fear of overlooking the condition itself remains. Thus, routine scrotal exploration in every patient with acute scrotal pain is common at many centers. We assessed

2012 Journal of Urology

7. Torsion of the Testis and its Appendages During Childhood (PubMed)

Torsion of the Testis and its Appendages During Childhood 14452315 1998 11 01 2018 12 01 0003-9888 37 1962 Apr Archives of disease in childhood Arch. Dis. Child. Torsion of the testis and its appendages during childhood. 214-26 JONES P P eng Journal Article England Arch Dis Child 0372434 0003-9888 OM Disease Extremities Humans Male Testicular Diseases Testis TESTIS/diseases 1962 4 1 1962 4 1 0 1 1962 4 1 0 0 ppublish 14452315 PMC2018912 J Anat Physiol. 1893 Oct;28(Pt 1):107-116.1 17232062 Br

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1962 Archives of Disease in Childhood

8. Torsion of the Testis and its Appendages (PubMed)

Torsion of the Testis and its Appendages In a survey of 101 cases with an index diagnosis of torsion of the testis or its appendage, there were 86 instances of torsion of the testis and 14 of torsion of the hydatid of Morgagni. In 38 of the patients with testicular torsion there were one or more "warning" attacks of pain and swelling, due to torsion which became spontaneously untwisted. In 19 cases operative fixation was performed because of this warning history, and all the testes were (...) preserved. In the other 19 the testes were not explored until the patient came in with a severe "classical" episode of torsion: seven of these testicles were lost from gangrene or delayed atrophy.In 31 cases torsion resulted in failure to save the testis. Of these, 20 were misdiagnosed and treated initially as epididymo-orchitis, despite there being no evidence of a urinary tract infection. There is no excuse for not exploring any actuely inflammed testicle which is unaccompanied by definite evidence

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1972 British medical journal

9. Outcomes of scrotal exploration for acute scrotal pain suspicious of testicular torsion: a consecutive case series of 173 patients. (PubMed)

during scrotal exploration, relationship between patient age and cause of scrotal pain, orchidectomy rate and the association between testicular torsion and cold weather.• Data for 173 patients out of 179 was available for analysis. • The median age of the patients was 14 (0-92) years. 51% (n = 89) had testicular torsion, 24% (n = 42) had torsion of testicular appendages, 9% (n = 16) had epididymo-orchitis, and other pathology made up 5%. • No obvious pathology was seen in 10% (n = 17). • Patients (...) with Torsion of Appendages were significantly younger than other patients with scrotal pain (P < 0.0001). • Age was not useful in discriminating between patients with Testicular Torsion from other patients with scrotal pain. 9% (n = 16) of all patients required an orchidectomy. • Frequency of Testicular Torsion was higher during the colder half of the year (n = 0.02).• Testicular torsion was the most common finding at surgical exploration, followed by torsion of testicular appendages. • Age had limited

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2011 BJU international

10. Acute Testicular Pain

Pain Aka: Acute Testicular Pain , Testicular Pain , Scrotal Pain , Acute Scrotum From Related Chapters II. Causes: Common Acute Causes of Scrotal Pain to Strangulated III. Causes: Uncommon Acute Causes of Scrotal Pain (5% of Testicular Pain cases) Familial mediterranean fever Local Associated with Associated with testicular appendage or venomous bite Torsion of Torsion of IV. References Images: Related links to external sites (from Bing) These images are a random sampling from a Bing search (...) Acute Testicular Pain Acute Testicular Pain Toggle navigation Brain Head & Neck Chest Endocrine Abdomen Musculoskeletal Skin Infectious Disease Hematology & Oncology Cohorts Diagnostics Emergency Findings Procedures Prevention & Management Pharmacy Resuscitation Trauma Emergency Procedures Ultrasound Cardiovascular Emergencies Lung Emergencies Infectious Disease Pediatrics Neurologic Emergencies Skin Exposure Miscellaneous Abuse Cancer Administration 4 Acute Testicular Pain Acute Testicular

2018 FP Notebook

11. Testicular Ultrasound

of ) is first region of epididymis affected Darker, less echogenic appearance due to increased water content (similar to appearance) Decreased or absent testicular arterial and venous blood flow as compared with the opposite side Affected may be enlarged Necrotic testicular regions may appear with a mix of hypoechoic and heterogeneous areas Reactive may be present Torsion of the appendix Mimics Diminished flow and swelling of the affected testicular appendage Testicular rupture VI. Findings: Painless (...) on contralateral (good, normal, painless) side Adjust color doppler settings (drop down doppler gain to improve sensitivity for torsion) Identify at least one set of intra-testicular vessels (one will be blue and the other red) Turn on pulse wave doppler and move calipers to each vessel in turn Demonstrate that one vessel has pulsatile characteristics (artery) Demonstrate that one vessel has more continuous characteristics (vein) This technique can be simulated and practiced on the Demonstrating both venous

2018 FP Notebook

12. Torsion of the Appendices and Epididymis (Diagnosis)

processing > Torsion of the Appendices and Epididymis Updated: Oct 20, 2016 Author: Jason S Chang, MD; Chief Editor: Erik D Schraga, MD Share Email Print Feedback Close Sections Sections Torsion of the Appendices and Epididymis Overview Background Torsion of testicular appendages can result in the clinical presentation of acute scrotum. Two such appendages are the appendix testis, a remnant of the paramesonephric (müllerian) duct, and the appendix epididymis, a remnant of the mesonephric (wolffian) duct (...) . The appendix testis is present in 92% of all testes and is usually located at the superior testicular pole in the groove between the testicle and the epididymis. The appendix epididymis is present in 23% of testes and usually projects from the head of the epididymis, but its location may vary. Most acute presentations of scrotal pain and swelling can be attributed to epididymitis, testicular torsion, or torsion of a testicular appendage. The presentations of these conditions can typically be distinguished

2014 eMedicine Emergency Medicine

13. Torsion of the Appendices and Epididymis (Treatment)

in torsion of testicular appendages. Eur J Nucl Med . 1996 Aug. 23(8):967-70. . Saxena AK, Castellani C, Ruttenstock EM, Höllwarth ME. Testicular Torsion: A 15-Year Single Center Clinical and Histological Analysis. Acta Paediatr . 2012 Mar 3. . Barloon TJ, Weissman AM, Kahn D. Diagnostic imaging of patients with acute scrotal pain. Am Fam Physician . 1996 Apr. 53(5):1734-50. . Fisher R, Walker J. The acute paediatric scrotum. Br J Hosp Med . 1994 Mar 16-Apr 5. 51(6):290-2. . Holland JM, Graham JB (...) , Ignatoff JM. Conservative management of twisted testicular appendages. J Urol . 1981 Feb. 125(2):213-4. . Hormann M, Balassy C, Philipp MO, Pumberger W. Imaging of the scrotum in children. Eur Radiol . 2004 Jun. 14(6):974-83. . Johnson KA, Dewbury KC. Ultrasound imaging of the appendix testis and appendix epididymis. Clin Radiol . 1996 May. 51(5):335-7. . Kadish HA, Bolte RG. A retrospective review of pediatric patients with epididymitis, testicular torsion, and torsion of testicular appendages

2014 eMedicine Emergency Medicine

14. Torsion of the Appendices and Epididymis (Overview)

processing > Torsion of the Appendices and Epididymis Updated: Oct 20, 2016 Author: Jason S Chang, MD; Chief Editor: Erik D Schraga, MD Share Email Print Feedback Close Sections Sections Torsion of the Appendices and Epididymis Overview Background Torsion of testicular appendages can result in the clinical presentation of acute scrotum. Two such appendages are the appendix testis, a remnant of the paramesonephric (müllerian) duct, and the appendix epididymis, a remnant of the mesonephric (wolffian) duct (...) . The appendix testis is present in 92% of all testes and is usually located at the superior testicular pole in the groove between the testicle and the epididymis. The appendix epididymis is present in 23% of testes and usually projects from the head of the epididymis, but its location may vary. Most acute presentations of scrotal pain and swelling can be attributed to epididymitis, testicular torsion, or torsion of a testicular appendage. The presentations of these conditions can typically be distinguished

2014 eMedicine Emergency Medicine

15. Torsion of the Appendices and Epididymis (Follow-up)

in torsion of testicular appendages. Eur J Nucl Med . 1996 Aug. 23(8):967-70. . Saxena AK, Castellani C, Ruttenstock EM, Höllwarth ME. Testicular Torsion: A 15-Year Single Center Clinical and Histological Analysis. Acta Paediatr . 2012 Mar 3. . Barloon TJ, Weissman AM, Kahn D. Diagnostic imaging of patients with acute scrotal pain. Am Fam Physician . 1996 Apr. 53(5):1734-50. . Fisher R, Walker J. The acute paediatric scrotum. Br J Hosp Med . 1994 Mar 16-Apr 5. 51(6):290-2. . Holland JM, Graham JB (...) , Ignatoff JM. Conservative management of twisted testicular appendages. J Urol . 1981 Feb. 125(2):213-4. . Hormann M, Balassy C, Philipp MO, Pumberger W. Imaging of the scrotum in children. Eur Radiol . 2004 Jun. 14(6):974-83. . Johnson KA, Dewbury KC. Ultrasound imaging of the appendix testis and appendix epididymis. Clin Radiol . 1996 May. 51(5):335-7. . Kadish HA, Bolte RG. A retrospective review of pediatric patients with epididymitis, testicular torsion, and torsion of testicular appendages

2014 eMedicine Emergency Medicine

16. Acute Testicular Pain

Pain Aka: Acute Testicular Pain , Testicular Pain , Scrotal Pain , Acute Scrotum From Related Chapters II. Causes: Common Acute Causes of Scrotal Pain to Strangulated III. Causes: Uncommon Acute Causes of Scrotal Pain (5% of Testicular Pain cases) Familial mediterranean fever Local Associated with Associated with testicular appendage or venomous bite Torsion of Torsion of IV. References Images: Related links to external sites (from Bing) These images are a random sampling from a Bing search (...) Acute Testicular Pain Acute Testicular Pain Toggle navigation Brain Head & Neck Chest Endocrine Abdomen Musculoskeletal Skin Infectious Disease Hematology & Oncology Cohorts Diagnostics Emergency Findings Procedures Prevention & Management Pharmacy Resuscitation Trauma Emergency Procedures Ultrasound Cardiovascular Emergencies Lung Emergencies Infectious Disease Pediatrics Neurologic Emergencies Skin Exposure Miscellaneous Abuse Cancer Administration 4 Acute Testicular Pain Acute Testicular

2015 FP Notebook

17. Testicular Ultrasound

of ) is first region of epididymis affected Darker, less echogenic appearance due to increased water content (similar to appearance) Decreased or absent testicular arterial and venous blood flow as compared with the opposite side Affected may be enlarged Necrotic testicular regions may appear with a mix of hypoechoic and heterogeneous areas Reactive may be present Torsion of the appendix Mimics Diminished flow and swelling of the affected testicular appendage Testicular rupture VI. Findings: Painless (...) on contralateral (good, normal, painless) side Adjust color doppler settings (drop down doppler gain to improve sensitivity for torsion) Identify at least one set of intra-testicular vessels (one will be blue and the other red) Turn on pulse wave doppler and move calipers to each vessel in turn Demonstrate that one vessel has pulsatile characteristics (artery) Demonstrate that one vessel has more continuous characteristics (vein) This technique can be simulated and practiced on the Demonstrating both venous

2015 FP Notebook

18. Color Doppler Sonography Reliably Identifies Testicular Torsion in Boys. (PubMed)

of duration of symptoms up to surgical exploration was 26.4 +/- 37.3 hours. All patients had standardized CDS of the scrotum. At surgery, 62 boys (20.9%) were diagnosed with TT, 168 (56.4%) with torsion of a testicular appendage (TA), and 24 (8.1%) with epididymitis. In 34 patients (11.4%), the cause of pain could not be identified during surgery. Overall CDS sensitivity, specificity, positive predictive value, and negative predictive value for TT diagnosis was 96.8%, 97.9%, 92.1%, and 99.1%, respectively (...) Color Doppler Sonography Reliably Identifies Testicular Torsion in Boys. To compare the results of preoperative scrotal color Doppler ultrasonography (CDS) and final diagnosis of subsequent surgical exploration in cases of suspected testicular torsion (TT).This retrospective study included 298 boys with acute scrotum whose clinical presentation was suspicious of TT and who subsequently underwent emergency surgery regardless of CDS results.Mean patient age was 11.4 +/- 4.1 years. The mean time

2009 Urology

19. Paediatric Urology

in scrotal emergencies. J Ultrasound, 2013. 16: 171. 147. Remer, E.M., et al. ACR Appropriateness Criteria (R) acute onset of scrotal pain--without trauma, without antecedent mass. Ultrasound Q, 2012. 28: 47. 148. Kadish, H.A., et al. A retrospective review of pediatric patients with epididymitis, testicular torsion, and torsion of testicular appendages. Pediatrics, 1998. 102: 73. 149. Sauvat, F., et al. [Age for testicular torsion?]. Arch Pediatr, 2002. 9: 1226. 150. Somekh, E., et al. Acute (...) scintigraphy in 49 patients with acute scrotal pain: a comparison with ultrasonography. Ann Nucl Med, 2001. 15: 225. 168. Karmazyn, B., et al. Duplex sonographic findings in children with torsion of the testicular appendages: overlap with epididymitis and epididymoorchitis. J Pediatr Surg, 2006. 41: 500. 169. Lau, P., et al. Acute epididymitis in boys: are antibiotics indicated? Br J Urol, 1997. 79: 797. 170. Abul, F., et al. The acute scrotum: a review of 40 cases. Med Princ Pract, 2005. 14: 177. 171

2019 European Association of Urology

20. Paediatric Urology

in scrotal emergencies. J Ultrasound, 2013. 16: 171. 147. Remer, E.M., et al. ACR Appropriateness Criteria (R) acute onset of scrotal pain--without trauma, without antecedent mass. Ultrasound Q, 2012. 28: 47. 148. Kadish, H.A., et al. A retrospective review of pediatric patients with epididymitis, testicular torsion, and torsion of testicular appendages. Pediatrics, 1998. 102: 73. 149. Sauvat, F., et al. [Age for testicular torsion?]. Arch Pediatr, 2002. 9: 1226. 150. Somekh, E., et al. Acute (...) scintigraphy in 49 patients with acute scrotal pain: a comparison with ultrasonography. Ann Nucl Med, 2001. 15: 225. 168. Karmazyn, B., et al. Duplex sonographic findings in children with torsion of the testicular appendages: overlap with epididymitis and epididymoorchitis. J Pediatr Surg, 2006. 41: 500. 169. Lau, P., et al. Acute epididymitis in boys: are antibiotics indicated? Br J Urol, 1997. 79: 797. 170. Abul, F., et al. The acute scrotum: a review of 40 cases. Med Princ Pract, 2005. 14: 177. 171

2018 European Association of Urology

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