Pediatric emergency medicine trisk 1179 1179

FIGURE 61.5 Torsion of testis Because torsion typically occurs in a medial direction, manual detorsion should be attempted initially by rotating the testis outward toward the thigh If the child is seen early after the onset of pain, scrotal tenderness and swelling may be localized to the area of the twisted appendage, typically on the superior lateral aspect of the testis It may be possible to have the patient point to the specific point of pain If the site indicated is at the upper pole of the testis, a palpable, localized tender mass with the remainder of the testis being nontender, makes torsion of a testicular appendage likely Although the classic “blue dot” sign of an infarcted appendage may be visualized through the scrotal skin, it often cannot be seen due to overlying edema Later in the clinical course, increased scrotal tenderness and edema make differentiation from torsion of the testis difficult The cremasteric reflex should be intact Color Doppler ultrasound