0071643192.pdf

RENAL AND GENITOURINARY

EMERGENCIES

SYMPTOMS/EXAM

■ Hallmark is asymptomatictesticular mass, firmness, or induration.

■ Exam may show scrotal swelling or a palpable mass.

DIAGNOSIS

■ Ultrasound can confirm the presence of a mass.

TREATMENT

■ Urgent urologic referral

Appendageal Torsion

The testicle has four appendages. Torsion of the appendix testis(90%) and

theappendix epididymis(8%) account for virtually all cases of appendageal

torsion. The appendix testis attaches to the upper pole of the testes and the

appendix epididymis to the head of the epididymis. Appendageal torsion is

most frequently seen in preadolescent boys.

SYMPTOMS

■ Acute onset of scrotal pain with a discrete painful testicular or epididymal mass

■ Less commonly, associated with nausea/vomiting, dysuria, urgency, or

frequency

EXAM

■ Tender and discrete scrotal “nodule”

■ Blue-black dot when present with transillumination of the testicle (blue-

dot sign) is pathognomonic (see Figure 18.8).

DIAGNOSIS

■ Primarily clinical

■ Doppler ultrasound and radionuclide scanning that illustrates decreased

blood flow to the appendage

Painless testicular mass =

cancer until proven otherwise.

“Blue-dot sign” with

transillumination of scrotal

skin = appendageal torsion.

FIGURE 18.8. Blue-dot sign indicating appendageal torsion. (See also color insert.)

(Courtesy of Javier A. Gonzalez del Rey, MD as published in Knoop KJ, Stack LB, Storrow AB.

Atlas of Emergency Medicine,2nd ed. New York: McGraw-Hill, 2002:220.)