Acute Scrotum: Difference between revisions

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==== Risk Factors (3) ====

#'''~~Commonly attributed to excess mobility of the testis within a “bell~~-clapper deformity”, wherein the tunica vaginalis abnormally fixes proximally on the cord'''

#'''“Bell-clapper deformity” wherein the tunica vaginalis abnormally fixes proximally on the cord, resulting in excess mobility of the testis'''

#'''Familial predisposition'''

#'''Cryptorchid testes'''

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* '''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 =====

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==== Option ====

*'''Orchiopexy'''

*'''Manual detorsion can be attempted. However, manual detorsion may not totally correct the rotation that has occurred and ~~that~~ prompt exploration is still indicated'''

*'''Manual detorsion can be attempted. However, manual detorsion may not totally correct the rotation that has occurred and prompt exploration is still indicated'''

===== Orchiopexy =====

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==Torsion of the Appendix Testis and Epididymis==

=== Background ===

*Appendix testis

**From the müllerian duct

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**From the wolffian duct

**Present in 22-28% of testes

*'''~~The peak~~ age at occurrence is 7 to 12 years'''

=== Epidemiology ===

*'''Peak age at occurrence is 7-12 years'''

=== Diagnosis and Evaluation ===

*'''History and Physical Exam'''

**'''Physical Exam'''

***'''“Blue dot sign”: a discoloration at the upper pole of the testis representing the ischemic appendage, may be seen through stretched scrotal skin'''

*'''Imaging'''

**'''US'''

***'''Rarely demonstrates an abnormal appendage'''

****The normal appendix testis contains no internal blood flow, whereas the twisted appendage may appear as an ovoid hyperechoic, hypoechoic, or heterogeneous nodule without blood flow

***'''Commonly shows hyperperfusion of the epididymis.'''

=== Management ===

*'''Observation'''

**Torsion of an appendage is a self-limited process; surgery is rarely indicated

==Epididymitis==

*'''Diagnosis and Evaluation'''

**'''History and Physical Exam'''

**'''Symptoms have a more insidious onset than torsion of the cord or an appendage''' but may be present rapidly

***'''Physical Exam'''

**'''The cremasteric reflex should be intact'''

****'''A “blue dot sign”, a discoloration at the upper pole of the testis representing the ischemic appendage, may be seen through stretched scrotal skin'''

**'''The majority of infants with epididymitis have sterile urine and apparently radiographically normal urinary tracts.'''

**'''Imaging'''

*Management

***'''US'''

**Goal is to relieve inflammation and any associated infection

****'''The normal appendix testis contains no internal blood flow, whereas the twisted appendage may appear as an ovoid hyperechoic, hypoechoic, or heterogeneous nodule without blood flow'''

****'''CDUS rarely demonstrates an abnormal appendage but commonly shows hyperperfusion of the epididymis.'''

*'''Management'''

**'''Torsion of an appendage is a self-limited process; surgery is rarely indicated'''

~~==Epididymitis==~~

*'''Symptoms have a more insidious onset than torsion of the cord or an appendage''' but may be present rapidly

*'''The cremasteric reflex should be intact'''

*'''The majority of infants with epididymitis have sterile urine and apparently radiographically normal urinary tracts.'''

*~~'''The management goal~~ is to relieve inflammation and any associated infection~~'''~~

*'''In a prepubertal child with a positive urine culture, renal US and VCUG are indicated''' (different than elsewhere that only describe a renal US for child with first UTI)

==References==

*Wein AJ, Kavoussi LR, Partin AW, Peters CA (eds): CAMPBELL-WALSH UROLOGY, ed 11. Philadelphia, Elsevier, 2015, chap 21

*Velasquez, James, Michael P. Boniface, and Michael Mohseni. "[https://www.ncbi.nlm.nih.gov/books/NBK470335/ Acute scrotum pain.]" (2017).

@@ Line 38: / Line 38: @@
 ==== Risk Factors (3) ====
-#'''<span style="color:#ff0000">Commonly attributed to excess mobility of the testis within a “bell-clapper deformity”, wherein the tunica vaginalis abnormally fixes proximally on the cord'''
+#'''<span style="color:#ff0000">“Bell-clapper deformity” wherein the tunica vaginalis abnormally fixes proximally on the cord, resulting in excess mobility of the testis'''
 #'''<span style="color:#ff0000">Familial predisposition'''
 #'''<span style="color:#ff0000">Cryptorchid testes'''
@@ Line 67: / Line 67: @@
 * '''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 =====
@@ Line 88: / Line 89: @@
 ==== Option ====
 *'''<span style="color:#ff0000">Orchiopexy'''
-*'''Manual detorsion can be attempted. However, manual detorsion may not totally correct the rotation that has occurred and that prompt exploration is still indicated'''
+*'''Manual detorsion can be attempted. However, manual detorsion may not totally correct the rotation that has occurred and prompt exploration is still indicated'''
 ===== Orchiopexy =====
@@ Line 158: / Line 159: @@
 ==Torsion of the Appendix Testis and Epididymis==
+=== Background ===
 *Appendix testis
 **From the müllerian duct
@@ Line 164: / Line 168: @@
 **From the wolffian duct
 **Present in 22-28% of testes
-*'''The peak age at occurrence is 7 to 12 years'''
+=== Epidemiology ===
+*'''Peak age at occurrence is 7-12 years'''
+=== Diagnosis and Evaluation ===
+*'''<span style="color:#ff0000">History and Physical Exam'''
+**'''<span style="color:#ff0000">Physical Exam'''
+***'''<span style="color:#ff0000">“Blue dot sign”: a discoloration at the upper pole of the testis representing the ischemic appendage, may be seen through stretched scrotal skin'''
+*'''Imaging'''
+**'''US'''
+***'''Rarely demonstrates an abnormal appendage'''
+****The normal appendix testis contains no internal blood flow, whereas the twisted appendage may appear as an ovoid hyperechoic, hypoechoic, or heterogeneous nodule without blood flow
+***'''Commonly shows hyperperfusion of the epididymis.'''
+=== Management ===
+*'''<span style="color:#ff0000">Observation'''
+**Torsion of an appendage is a self-limited process; surgery is rarely indicated
+==Epididymitis==
 *'''Diagnosis and Evaluation'''
-**'''History and Physical Exam'''
+**'''Symptoms have a more insidious onset than torsion of the cord or an appendage''' but may be present rapidly
-***'''Physical Exam'''
+**'''The cremasteric reflex should be intact'''
-****'''A “blue dot sign”, a discoloration at the upper pole of the testis representing the ischemic appendage, may be seen through stretched scrotal skin'''
+**'''The majority of infants with epididymitis have sterile urine and apparently radiographically normal urinary tracts.'''
-**'''Imaging'''
+*Management
-***'''US'''
+**Goal is to relieve inflammation and any associated infection
-****'''The normal appendix testis contains no internal blood flow, whereas the twisted appendage may appear as an ovoid hyperechoic, hypoechoic, or heterogeneous nodule without blood flow'''
-****'''CDUS rarely demonstrates an abnormal appendage but commonly shows hyperperfusion of the epididymis.'''
-*'''Management'''
-**'''Torsion of an appendage is a self-limited process; surgery is rarely indicated'''
-==Epididymitis==
-*'''Symptoms have a more insidious onset than torsion of the cord or an appendage''' but may be present rapidly
-*'''The cremasteric reflex should be intact'''
-*'''The majority of infants with epididymitis have sterile urine and apparently radiographically normal urinary tracts.'''
-*'''The management goal is to relieve inflammation and any associated infection'''
-*'''In a prepubertal child with a positive urine culture, renal US and VCUG are indicated''' (different than elsewhere that only describe a renal US for child with first UTI)
 ==References==
 *Wein AJ, Kavoussi LR, Partin AW, Peters CA (eds): CAMPBELL-WALSH UROLOGY, ed 11. Philadelphia, Elsevier, 2015, chap 21
 *Velasquez, James, Michael P. Boniface, and Michael Mohseni. "[https://www.ncbi.nlm.nih.gov/books/NBK470335/ Acute scrotum pain.]" (2017).