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Torsion of Testicular Appendage

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41. Epididymitis

in Epididymitis and >24 mg/L in most cases is typically normal in processing time may preclude use to triage (96%) (92%) testing (PCR l swab or first-void urine) PCR PCR XII. Imaging: Color doppler Scrotal Ultrasound Indications Consider in all cases where cannot otherwise be excluded Differentiates Epididymitis and (increased blood flow) from (absent blood flow) Epididymitis Epididymis with increased blood flow, hyperemia and swelling Decreased or absent testicular blood flow Torsion of appendix Appendage (...) and unilateral pain may recur if torsion is intermittent (rare in Epididymitis) may also present with sudden unilateral and often comorbid with Epididymitis Symptoms of (rare in ) l discharge Urinary urgency X. Signs Epididymis inflammation Tenderness to palpation at the epididymis, superior and posterolateral to Epididymis is enlarged and indurated Adjacent scrotal and testicular inflammation may occur with or infection and both cause testicular swelling, scrotal erythema, reactive present in both

2015 FP Notebook

42. Scrotal Pain

Platform Loading , MD, David Geffen School of Medicine at UCLA Click here for Patient Education NOTE: This is the Professional Version. CONSUMERS: Topic Resources Scrotal pain can occur in males of any age, from neonates to the elderly. Podcast Etiology The most common causes of scrotal pain include Torsion of the testicular appendage There are a number of less common causes (see Table: ). Age, onset of symptoms, and other findings can help determine the cause. Table Some Causes of Scrotal Pain Cause (...) of the testicular appendage occurs most commonly in prepubertal boys (7 to 14 yr), and is most common in adolescents and adults. Severe, sudden onset of pain suggests testicular torsion or . Pain from epididymitis, incarcerated hernia, or is of more gradual onset. Patients with torsion of the testicular appendage present with moderate pain that develops over a few days; pain is localized to the upper pole. Bilateral pain suggests infection (eg, orchitis, particularly if accompanied by fever and viral symptoms

2013 Merck Manual (19th Edition)

43. Surgical Emergencies in Childhood

into the stomach. Both these methods are thought to be more cost-effective than endoscopy. The use of Magill forceps to remove objects from the upper oesophagus has been described. Torsion of the testis An acute scrotum in a child requires surgical exploration for a definitive diagnosis. A retrospective analysis of all boys aged less than 15 years old presenting with over a 2-year period revealed: [ ] 27% had . 57% had a torted appendage testis. 11% had . 1% had fat necrosis. 4% had no abnormality detected. 29 (...) exploration in all cases is the investigation and intervention of choice in the acute paediatric scrotum. Pediatr Surg Int. 2006 May22(5):413-6. Epub 2006 Apr 7. ; Clinical predictors for testicular torsion as seen in the pediatric ED. Am J Emerg Med. 2010 Sep28(7):786-9. Epub 2010 Feb 25. ; Role of Doppler ultrasonography in the triage of acute scrotum in the emergency J Ultrasound Med. 2010 Jan29(1):11-21. my grandson has a scab on his right thigh, it was small a few days ago. I did not think much

2008 Mentor

44. Hydrocele

the article more useful, or one of our other . In this article In This Article Hydrocele In this article A hydrocele is an abnormal collection of fluid within the remnants of the processus vaginalis. Simple hydrocele Accumulation of fluid within the tunica vaginalis. Affects 1-2% of male neonates. A congenital, simple hydrocele usually disappears within the first 1-2 years of life. Causes in older boys and men include trauma, epididymo-orchitis, testicular torsion, hernia, varicocele, and testicular (...) and reabsorption of fluid Can occur secondary to minor trauma, testicular torsion, epididymitis, varicocele operation or following a repair of a hydrocele. Hydrocele of the cord The processus vaginalis closes segmentally, trapping fluid within the spermatic cord. Abdomino-scrotal hydrocele Rare; a large hydrocele lies across the internal ring, with both inguino-scrotal and intra-abdominal lobes. Hydroceles need to be fully investigated if there is any suspicion of an underlying cause. In children, most

2008 Mentor

45. Lumps in the Groin and Scrotum

, , . Nontender nodes. Femoral hernia. . Vascular: . (varicosity of saphenous vein at the junction with the femoral vein). Scrotal lumps [ ] Painful lumps: . Torsion of a testicular or epididymal appendage. . . Haematocele/haematoma. Painless lumps: Inguinal hernia (may sometimes be painful). . . Spermatocele (feels similar to epididymal cyst but is filled with semen). . . Skin swellings (as for groin lumps). Less common causes of scrotal swelling include: Idiopathic scrotal oedema (mainly children (...) [ ] History Pain. Duration and speed of onset (sudden in testicular torsion, more gradual in epididymo-orchitis). Change in size. Trauma. Note whether it reduces (eg, on lying down). Previous episodes. (Those with testicular torsion may have had previous self-limiting episodes.) Associated symptoms: Urethral discharge or dysuria (suggests epididymo-orchitis). Abdominal pain, nausea and vomiting (can occur with testicular torsion). Back pain, weight loss, dyspnoea (can occur with metastatic testicular

2008 Mentor

46. Torsion of the Testis

) is elicited by gentle pinching or stroking of the inner thigh while observing the scrotal contents. If the torsion occurs prenatally, the baby is born with a firm, hard, non-transilluminable scrotal mass. There are no symptoms. The scrotal skin is usually fixed to the underlying necrotic testis. Differential diagnosis Torsion of testicular or epididymal appendage: This usually occurs in boys aged between 7 and 12 years. Systemic symptoms are rare. There is usually localised tenderness but only (...) and references ; Urologic Emergencies. Surg Clin North Am. 2016 Jun96(3):407-24. doi: 10.1016/j.suc.2016.02.001. ; Sonography of the scrotum: from appendages to scrotolithiasis. J Ultrasound Med. 2015 Mar34(3):507-18. doi: 10.7863/ultra.34.3.507. ; Ultrasonography of the scrotum in adults. Ultrasonography. 2016 Feb 24. doi: 10.14366/usg.15075. ; European Association of Urology (2015) ; Testicular torsion and the acute scrotum: current emergency management. Eur J Emerg Med. 2016 Jun23(3):160-5. doi: 10.1097

2008 Mentor

47. Torsion of the testicular appendix: importance of associated acute inflammation. (PubMed)

appendages. No other association was detected between the pattern or degree of acute inflammatory cell infiltrate and any other clinicopathological variable that may indicate pyogenic infection. No bacteria or fungal elements were identified. Marked lymphatic dilation may be the only histological finding to indicate the presence of early torsion in cases of scrotal pain secondary to torsion of the appendix testis.Heavy acute inflammatory cell infiltrates in the torted testicular appendix can be regarded (...) Torsion of the testicular appendix: importance of associated acute inflammation. Torsion of the testicular appendix is the commonest cause of acute scrotum in children. The histological picture of these cases is variable and many show a heavy acute inflammatory cell infiltrate, unlike the response to pure ischaemic necrosis in other organs. The clinical implications and consequences of this associated inflammation are not clear.A retrospective review of all cases presenting with torsion

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2006 Journal of Clinical Pathology

48. Duplex sonographic findings in children with torsion of the testicular appendages: overlap with epididymitis and epididymoorchitis. (PubMed)

Duplex sonographic findings in children with torsion of the testicular appendages: overlap with epididymitis and epididymoorchitis. Torsion of the testicular appendages (TTA) is the most common cause of acute scrotum in children, and yet there are only few dedicated studies of the imaging findings.To review our experience with the use of duplex sonography in children with TTA and to evaluate if sonography can successfully distinguish TTA from epididymoorchitis.We reviewed the medical files (...) and imaging findings of 29 children aged 0.7 to 13.9 years (mean, 6.5 years) with a diagnosis of TTA based on testicular exploration who were evaluated preoperatively with duplex sonography.A tender upper pole nodule, the typical sign of TTA, was palpated in only 2 (6.9%) children. Duplex sonography demonstrated an extratesticular upper pole nodule in 9 (31%) children. Secondary inflammatory changes included hydrocele in 22 (75.9%), enlarged epididymis in 22 (75.9%), scrotal wall edema in 16 (55.2

2006 Journal of Pediatric Surgery

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