Distinguishing testicular torsion from torsion of the appendix testis by clinical features and signs in patients with acute scrotum

Fujita, Naoyuki; Tambo, Mitsuhiro; Okegawa, Takatsugu; Higashihara, Eiji; Nutahara, Kikuo

doi:10.2147/rru.s140361

Cited by 14 publications

(37 citation statements)

References 25 publications

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“…Overall, 70% had been diagnosed with testicular torsion and the other 30% with torsion of the appendix testis. 2 It was noted that 87.8% of patients with testicular torsion reported a duration of pain of less than 24 hours. The study also reported that more patients with testicular torsion reported or presented with onset of pain during sleep (67.3% vs 33%), testicular swelling (79.6% vs 52.4%) and a high-riding testicle (61.2% vs 33.3%).…”

Section: Clinical Presentationmentioning

confidence: 99%

“…The study also reported that more patients with testicular torsion reported or presented with onset of pain during sleep (67.3% vs 33%), testicular swelling (79.6% vs 52.4%) and a high-riding testicle (61.2% vs 33.3%). 2 Another retrospective study conducted in pediatric patients with a median age of 10 years and presenting with acute scrotum reported that 19 out of 138 patients were diagnosed with testicular torsion. Patients with testicular torsion in this study were on average older age than patients presenting with other causes of acute scrotum.…”

Section: Clinical Presentationmentioning

confidence: 99%

“…1 The severity of ischemia varies and is dependent on the time period of torsion as well as the extent of rotation of the cord. 2 Testicular torsion can occur at any age but commonly occurs soon after birth or between the ages of 12-18 years with a peak in incidence at age 13-14 years. The incidence of torsion in males below the age of 25 years is approximately 1 in 4000.…”

Section: Introductionmentioning

confidence: 99%

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<p>Testicular Torsion in the Emergency Room: A Review of Detection and Management Strategies</p>

Laher¹,

Ragavan²,

Mehta³

et al. 2020

OAEM

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Testicular torsion is a challenging and time-sensitive diagnosis that is encountered frequently in daily practice, especially in the emergency room. A thorough history, the presence of a painful and swollen testis and testicular ultrasonography plays a vital role in the prompt diagnosis of testicular torsion. Prompt diagnosis is essential to prevent complications of testicular torsion which include testicular infarction, necrosis, and sub/infertility. This can be challenging as there are various other conditions that may mimic the presentation of testicular torsion. Since testicular torsion is an extremely time-sensitive diagnosis, it may also be a subject of many medicolegal challenges. This review article serves as a guide for clinicians involved with the diagnosis and management of testicular torsion. We review and discuss detection and management strategies based on their validity, statistical significance, and effectiveness in enabling prompt diagnosis and management of testicular torsion. Medicolegal implications of testicular torsion are also highlighted.

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Section: Clinical Presentationmentioning

confidence: 99%

Section: Clinical Presentationmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

<p>Testicular Torsion in the Emergency Room: A Review of Detection and Management Strategies</p>

Laher¹,

Ragavan²,

Mehta³

et al. 2020

OAEM

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“…While worth knowing, the "blue dot sign" is only present in about 21% (0 to 52%) of all torsed testicular appendages and a false positive "blue dot sign" has been reported in the literature in a patient with testicular torsion [12]. In an effort to improve diagnostic accuracy and avoid needless surgery, precise grey scale and color Doppler ultrasonography have been performed to evaluate the cause of acute scrotum [13]. In young ages, testicular torsion, epididymitis, and torsion of the testicular appendages are the most common etiologies of acute scrotum [8,[14][15][16].…”

Section: Discussionmentioning

confidence: 99%

Torsion of the Testicular Appendages in Adult Acute Scrotum

Saito¹

2019

IJCU

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Adult patients with acute scrotum sometimes tend to be treated for epididymitis without undergoing ultrasonographic examination, although precise ultrasonography reveals that there are some patients with torsion of the testicular appendages. In this report, I investigate the incidence of patients with torsion of the testicular appendages among patients with adult acute scrotum, who mainly used to be treated for epididymitis. In the last 5 years, 46 patients (23~62, average age 43.5 years) with scrotal pain and swelling visited our clinic for diagnosis and treatment. On an outpatient basis, their symptoms were evaluated, and blood tests, urinalysis, and grey scale and color Doppler ultrasonography with a 5-12 MHz linear scan were performed. Five (10.9%) of the 46 patients were diagnosed as having torsion of the testicular appendages. Although none of them had a high fever, 4 of the 5 (80%) had nausea and abdominal pain. Leukocytosis and pyuria were not found in any case. Typical ultrasound appearances were reactive hydrocele and a hyperechoic swollen mass or enlarged hyperechoic, spherical mass of the appendage. On color Doppler ultrasonography, there was no blood flow within the torsed appendage testis, and an increase in periappendiceal blood flow was seen in all of the cases. They were treated conservatively with anti-inflammatory agents and cooling, and their symptoms disappeared within 2 weeks. It is suggested that as many as 10.9% of adult patients with scrotal pain and swelling may suffer from torsion of the testicular appendages. We should conduct ultrasonography for adult patients with acute scrotum.

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“…1,2 Confounding diagnoses include torsion of appendix testis, typically presenting with a more insidious onset and focal tenderness at the upper aspect of the testicle. 3 Epididymo-orchitis has a more insidious onset and may present with fever, dysuria or positive urinalysis. Hydroceles are typically painless and transilluminate.…”

mentioning

confidence: 99%

Testicular torsion

Keays

Rosenberg

2019

CMAJ

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Testicular torsion, the spontaneous twisting of the spermatic cord leading to compromise of testicular blood flow, occurs in 1/4000 males younger than 25 years and rarely in newborns. 1 Risk factors include underlying bell clapper deformity, undescended testicle, trauma and prior intermittent torsion. 1 2 Testicular torsion should be considered in patients with acute testicular pain or lower abdominal pain The risk of testicular torsion can be assessed with the TWIST (Testicular Workup for Ischemia and Suspected Torsion) score. Scoring is as follows: testicular swelling (2 points), hard testis (2 points), absent cremasteric reflex (1 point), nausea and vomiting (1 point), and high-riding testis (1 point). A score of 0 is predictive of nontorsion, and a score of 6 or 7 is highly predictive of testicular torsion. 2

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Distinguishing testicular torsion from torsion of the appendix testis by clinical features and signs in patients with acute scrotum

Cited by 14 publications

References 25 publications

<p>Testicular Torsion in the Emergency Room: A Review of Detection and Management Strategies</p>

<p>Testicular Torsion in the Emergency Room: A Review of Detection and Management Strategies</p>

Torsion of the Testicular Appendages in Adult Acute Scrotum

Testicular torsion

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