Overview Snapshot A neonatal boy is brought to his pediatrician for concern of a blue mass in the scrotum. His parents noticed this an hour ago. On physical exam, the scrotum is blue and firm with some erythema. Transillumination test is negative. Doppler ultrasound shows absent blood flow. The neonate is immediately sent to hospital for surgery. Introduction Clinical definition twisting of spermatic cord that results in compromised blood flow and ischemia this is considered a surgical emergency Epidemiology demographics neonatal adolescent years risk factors prior history of testicular torsion recent trauma to the testes Pathogenesis processus vaginalis (path as testes leaves abdomen with peritoneal lining) twists, causing decreased or absent blood flow to the testis and epididymis Prognosis prognostic variable favorable rapid time to surgery Presentation Symptoms primary symptoms in adolescents acute onset and severe pain in unilateral scrotum nausea vomiting in neonates blue and firm unilateral scrotal mass Physical exam inspection high riding testis with a horizontal lie erythema and swelling tenderness to palpation absent cremasteric reflex Imaging Doppler ultrasound indications if testicular torsion is suspected but not confirmed with physical exam and history findings decreased or absent blood flow Studies Urinalysis to rule out epididymitis Diagnostic criteria diagnosed by history and physical exam diagnosis confirmed only during surgery Differential Epididymitis positive cremasteric reflex Torsion of the appendix testis normal cremasteric reflex normal testicular lie positive blue dot sign Treatment Operative orchiopexy (bilateral) indications within 24 hours of disease onset 4-8 hour window before there is permanent damage from ischemia bilateral orchiopexy should be performed as contralateral testis is also at risk for future torsion outcomes 90-100% with viable testes if within 6 hours 50% if within 12 hours <10 % if after 24 hours orchiectomy indications if testis is not viable Non-operative manual detorsion indications if surgery is not available or delayed Complications Testicular ischemia Infertility or subfertility
QUESTIONS 1 of 5 1 2 3 4 5 Previous Next Sorry, this question is for PEAK Premium Subscribers only Upgrade to PEAK (M3.RL.12.25) A 15-year-old boy presents to the emergency room with severe lower abdominal pain that awoke him from sleep about 3 hours ago. The pain is sharp and radiates to his left thigh. While in the emergency room, the patient experiences one episode of vomiting. His temperature is 99.3°F (37.4°C), blood pressure is 126/81 mmHg, pulse is 119/min, respirations are 14/min, and oxygen saturation is 99% on room air. Abdominal examination reveals no tenderness in all 4 quadrants. Scrotal examination reveals an elevated left testicle that is diffusely tender. Stroking of the patient's inner thigh on the left side does not result in elevation of the testicle. What is the next step in the management of this patient? Tested Concept QID: 103048 Type & Select Correct Answer 1 CT scan of abdomen and pelvis 0% (0/13) 2 IV antibiotics 8% (1/13) 3 Observation and morphine 77% (10/13) 4 Surgical exploration 0% (0/13) 5 Testicular doppler ultrasound 0% (0/13) M 12 Question Complexity E Question Importance Select Answer to see Preferred Response SUBMIT RESPONSE 4 Review tested concept Sorry, this question is for PEAK Premium Subscribers only Upgrade to PEAK Sorry, this question is for PEAK Premium Subscribers only Upgrade to PEAK (M2.RL.12.4) A 16-year-old man presents to the emergency department with a 2-hour history of sudden-onset abdominal pain. He was playing football when his symptoms started. The patient’s past medical history is notable only for asthma. Social history is notable for unprotected sex with 4 women in the past month. His temperature is 99.3°F (37.4°C), blood pressure is 120/88 mmHg, pulse is 117/min, respirations are 14/min, and oxygen saturation is 99% on room air. Physical exam is noted for a non-tender abdomen. Testicular exam reveals a right testicle which is elevated with a horizontal lie and the scrotum is neither swollen nor discolored. Which of the following is the most likely diagnosis? Tested Concept QID: 103027 Type & Select Correct Answer 1 Appendicitis 67% (51/76) 2 Epididymitis 14% (11/76) 3 Seminoma 1% (1/76) 4 Testicular torsion 14% (11/76) 5 Traumatic urethral injury 0% (0/76) M 6 Question Complexity E Question Importance Select Answer to see Preferred Response SUBMIT RESPONSE 4 Review tested concept