Editing Acute Scrotum (section)

==== Diagnosis and Evaluation ====

===== History and Physical Exam =====
*'''History'''
**The inciting event for torsion is unknown
**History of prior episodes may be elicited
**Nausea/vomiting occurs in 10-60% of boys
**Dysuria and fever are uncommon
*'''<span style="color:#ff0000">Physical exam</span>'''
**'''<span style="color:#ff0000">Most common physical findings (4):</span>'''
**#'''<span style="color:#ff0000">Generalized testicular tenderness</span>'''
**#'''<span style="color:#ff0000">Abnormal (horizontal) orientation of the testis</span>'''
**#'''<span style="color:#ff0000">High-riding testis</span>''' from a foreshortened cord
**#'''<span style="color:#ff0000">Absent cremasteric/genitofemoral reflex</span>'''
**#*'''Elicited by scratching the inner thigh with resultant testis elevation'''
**#*'''Normally present age >2 years'''
**#*'''Some studies report reduced or absent reflex in all cases of testicular torsion, but intact in up to 10% of proven cases of torsion in other series'''
**Scrotal edema and erythema may be present, depending on the duration or degree of torsion.

===== Labs =====

* '''Urinalysis +/- culture'''
** Rule out infectious cause of acute scrotum
* '''CBC'''
** Rule out infectious cause of acute scrotum
[[File:43414588252 df2480a453 o.jpg|alt=Ultrasound with doppler demonstrating no flow to right testicle.|thumb|500x500px|Ultrasound with doppler demonstrating no flow to right testicle. [https://www.flickr.com/photos/iem-student/43414588252 Source]]]

===== Imaging =====
*'''Before the advent of reliable and rapid scrotal imaging, immediate scrotal exploration was routine'''
*'''<span style="color:#ff0000">Doppler Ultrasound'''
**'''<span style="color:#ff0000">Findings consistent with testicular torsion (2):'''
**#'''<span style="color:#ff0000">Reduced or absent Doppler color or waveforms'''
**#'''<span style="color:#ff0000">Parenchymal heterogeneity compared with the contralateral testis'''