Editing Testicular torsion (section)

== DDx: epididymitis, trauma, tumour ==

* Idiopathic scrotal oedema
** Usually aged 3-6yo
** Swelling is prominent feature - early swelling, which can be seen in perineum/inguinal region or base of penis
** Generally bilateral
** Also have pain, but not as bad, or may be pain-free
** Skin can be tender but testis and cord are normal
** Apparently often seen in atopic/anaphylactic kids - occasionally a/w eosinophilia
** Usually subsides within a day or two but may recur
* Torted testicular appendage
** Usually 3-11yo
** Most common structure to twist is pedunculated hydatid of Morgagni (testicular appendage)
** Palpate carefully for an exquisitely tender nodule at the upper pole, while body of testis is non-tender
** Transillumination may reveal blue dot sign
** Can still see quite prominent scrotal signs - swelling, erythema
** NSAIDs and will settle but can take up to a week
** Does not need admission
* Torted epididymal appendage
** Superiorly
* Acute epididymo-orchitis
** Unilateral epididymo-orchitis is rare in children, but when it occurs, it is probably associated with UTIs and anomalies of the urinary tract
** More common in older patients, often associated with dysuria
** Elevation of testis may reduce pain.
* Mumps
** Rarely occurs before puberty
** Usually bilateral
** Usually 3-7 days after onset of parotitis
** Check for elevated salivary amylase or real-time mumps PCR
** Cord not thickened, and is often bilateral
* Inguinal hernia
** Rare mimic - small tense strangulated hernia compressing the cord and causing compression of the pampiniform plexus



Aim for exploration within 6 hours, however even if >6 hours since onset, still worth rushing