Question of the Week # 244

244 )  A 10-year-old Caucasian boy presents with right scrotal pain of 7 hours duration. The pain is acute in onset, constant and does not change with position. The patient denies any fever, chills, dysuria, nausea or vomiting. He denies any recent history of trauma. On physical examination, the patient is afebrile and is in moderate distress secondary to pain. There is no urethral discharge. Cremasteric reflex is present bilaterally. There is bluish discoloration and localized tenderness in the upper part of the testes. Labs reveal a normal Complete Blood Count and Urinalysis. What is the most likely clinical diagnosis in this patient?

A)     Testicular torsion

B)      Strangulated Hernia

C)      Congenital Hydrocele

D)     Torsion of Testicular appendix

E)      Acute Epidydimitis





10 Responses

  1. A is the answer

  2. ddddddddddd

  3. b

  4. Acute onset, cremastric reflex present, upper pole tenderness and blue dot sign.. i go with D. Torision of testicular appendix

  5. A

  6. ddd

  7. D

  8. Physical examination may reveal the following findings[2] :

    The patient is afebrile with normal vital signs.
    Although the scrotum may be erythematous and edematous, it usually appears normal.
    An unreliable marker of pathology, the cremasteric reflex is usually intact. Several studies indicate that the presence of a cremasteric reflex in the acute scrotum is unlikely to be testicular torsion.
    The testis should be nontender to palpation. If present, tenderness is localized to the upper pole of the testis. Diffuse tenderness is more common in testicular torsion.
    The presence of a paratesticular nodule at the superior aspect of the testicle, with its characteristic blue-dot appearance, is pathognomonic for this condition. A blue-dot sign is present in only 21% of cases.
    The combination of a blue-dot sign with clear palpation of an underlying normal, nontender testes allows for the exclusion of testicular torsion on clinical grounds alone.
    Vertical orientation of the testes is preserved.
    A study in 2005 scored 3 key historical elements as predictors for testicular torsion. Onset of pain less than 6 hours, absence of cremasteric reflex, and diffuse testicular tenderness. Out of 141 subjects, in the absence of any of these elements, none of the subjects had testicular torsion. With all 3 elements present, 87% were diagnosed with testicular torsion.[3]

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