Testicular masses require early diagnosis, but treatment will not occur emergently Once diagnosed, the urologist will typically manage the testicular mass within the next to days Clinical Assessment If a testicular mass is palpated on examination, a scrotal ultrasound is warranted If a mass is found incidentally on ultrasound, further workup is also warranted All patients with a scrotal mass concerning for a tumor must undergo blood testing for AFP, bHCG, and LDH In addition, these patients need cross-sectional imaging of the abdomen Management A pediatric urologist must be consulted Once a testicular mass is identified, it will require resection Imaging and patient parameters will determine whether a partial orchiectomy is permissible, or a radical orchiectomy is required Torsion of the Appendix Testis Clinical Recognition A torsed appendix testis may present much like a testicular torsion by report, but the patient appears vastly different Pain is still a presenting complaint but torsion of an appendix less often awakes a patient from sleep, and is not associated with nausea or emesis The swelling is less pronounced, and a key finding on physical examination is focal tenderness at the superior aspect of the testis rather than the inferior testis The “blue dot” sign, in which a bluish hue is visible through the scrotal skin at the superior aspect of the testis, is an often elusive finding Triage Considerations Since the initial presentation may be similar to testicular torsion, a prompt evaluation with history and physical examination is essential to help guide evaluation and management Clinical Assessment The testis may be swollen and red; thus, a scrotal ultrasound is a valid tool for diagnosis This may identify the torsed appendage (though it does not always), but more often, and more importantly, will rule out testicular torsion Management Torsion of a testicular appendage is managed with supportive care The key component of treatment is administration of a nonsteroidal anti-inflammatory