SAQ 458 – Paediatrics – acute painful testis and suspected torsion

Paediatrics – acute painful testis and suspected torsion.

a. Features suggesting torsion

• Sudden onset severe unilateral testicular pain.
• Associated nausea or vomiting.
• No clear traumatic trigger.
• Exquisitely tender or swollen testis.
• High-riding or horizontal lie of the testis.
• Absent cremasteric reflex.
• No relief with elevation and possible scrotal erythema/discolouration.

b. Other diagnoses

• Torsion of the appendix testis or epididymis.
• Epididymitis or orchitis.
• Scrotal trauma.
• Idiopathic scrotal oedema.
• Henoch-Schonlein purpura.
• Incarcerated inguinal hernia.

c. Ultrasound

• Clinical torsion is a surgical emergency and ultrasound must not delay urological review or theatre.
• Ultrasound can assist if the diagnosis is genuinely equivocal and it is immediately available.
• A normal ultrasound does not overrule a high clinical suspicion of torsion.