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Torsion of Testicular Appendage
Sara M. O'Hara, MD, FAAP; A. Carlson Merrow, Jr., MD, FAAP
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KEY FACTS

  • Terminology

    • Imaging

      • Top Differential Diagnoses

        • Clinical Issues

          TERMINOLOGY

          • Synonyms

            • Twisted appendage, torsed appendix testis, torsion of appendix epididymis, appendiceal torsion
          • Definitions

            • Spontaneous twisting of pedunculated vestigial remnant along testicle or epididymis, causing ischemia & pain
            • Most common etiology of acute scrotal pain in children
              • Incidence >> epididymoorchitis & testicular torsion

          IMAGING

          • General Features

            • Ultrasonographic Findings

              • Nuclear Medicine Findings

                • Imaging Recommendations

                  DIFFERENTIAL DIAGNOSIS

                    PATHOLOGY

                    • General Features

                      • Microscopic Features

                        CLINICAL ISSUES

                        • Presentation

                          • Demographics

                            • Natural History & Prognosis

                              • Treatment

                                DIAGNOSTIC CHECKLIST

                                • Image Interpretation Pearls

                                  Selected References

                                  1. Lev M et al: Sonographic appearances of torsion of the appendix testis and appendix epididymis in children. J Clin Ultrasound. 43(8):485-9, 2015
                                  2. Boettcher M et al: Differentiation of epididymitis and appendix testis torsion by clinical and ultrasound signs in children. Urology. 82(4):899-904, 2013
                                  3. Delaney LR et al: Ultrasound of the pediatric scrotum. Semin Ultrasound CT MR. 34(3):248-56, 2013
                                  4. Nicolay L et al: Torsion of the appendix testis in an undescended testis: a case report. Can J Urol. 20(3):6805-7, 2013
                                  5. Yusuf GT et al: A review of ultrasound imaging in scrotal emergencies. J Ultrasound. 16(4):171-8, 2013
                                  6. Sung EK et al: Sonography of the pediatric scrotum: emphasis on the Ts--torsion, trauma, and tumors. AJR Am J Roentgenol. 198(5):996-1003, 2012
                                  7. Park SJ et al: Sonography of intrascrotal appendage torsion: varying echogenicity of the torsed appendage according to the time from onset. J Ultrasound Med. 30(10):1391-6, 2011
                                  8. Singh AK et al: Torsion of testicular appendage. Pediatr Radiol. 40(3):373, 2010
                                  9. Artas H et al: Scrotal calculi. J Ultrasound Med. 26(12):1775-9, 2007
                                  10. Varga J et al: Acute scrotal pain in children--ten years' experience. Urol Int. 78(1):73-7, 2007
                                  11. Baldisserotto M et al: Color Doppler sonography of normal and torsed testicular appendages in children. AJR Am J Roentgenol. 184(4):1287-92, 2005
                                  12. Yang DM et al: Torsed appendix testis: gray scale and color Doppler sonographic findings compared with normal appendix testis. J Ultrasound Med. 24(1):87-91, 2005
                                  13. Ciftci AO et al: Clinical predictors for differential diagnosis of acute scrotum. Eur J Pediatr Surg. 14(5):333-8, 2004
                                  14. Adams BK et al: Tc-99m blood-pool imaging in torsion of an epididymal appendix. Clin Nucl Med. 28(6):526, 2003
                                  15. Sellars ME et al: Ultrasound appearances of the testicular appendages: pictorial review. Eur Radiol. 13(1):127-35, 2003
                                  16. McAndrew HF et al: The incidence and investigation of acute scrotal problems in children. Pediatr Surg Int. 18(5-6):435-7, 2002
                                  17. Johnson DB et al: Mullerian-type epithelial tumor arising within a torsed appendix testis. Urology. 54(3):561, 1999
                                  18. Monga M et al: Metachronous bilateral torsion of the testicular appendices. Int J Urol. 6(11):589-91, 1999
                                  19. Van Glabeke E et al: Acute scrotal pain in children: results of 543 surgical explorations. Pediatr Surg Int. 15(5-6):353-7, 1999
                                  20. Strauss S et al: Torsion of the testicular appendages: sonographic appearance. J Ultrasound Med. 16(3):189-92; quiz 193-4, 1997
                                  Related Anatomy
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                                  Related Differential Diagnoses
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                                  References
                                  Tables

                                  Tables

                                  KEY FACTS

                                  • Terminology

                                    • Imaging

                                      • Top Differential Diagnoses

                                        • Clinical Issues

                                          TERMINOLOGY

                                          • Synonyms

                                            • Twisted appendage, torsed appendix testis, torsion of appendix epididymis, appendiceal torsion
                                          • Definitions

                                            • Spontaneous twisting of pedunculated vestigial remnant along testicle or epididymis, causing ischemia & pain
                                            • Most common etiology of acute scrotal pain in children
                                              • Incidence >> epididymoorchitis & testicular torsion

                                          IMAGING

                                          • General Features

                                            • Ultrasonographic Findings

                                              • Nuclear Medicine Findings

                                                • Imaging Recommendations

                                                  DIFFERENTIAL DIAGNOSIS

                                                    PATHOLOGY

                                                    • General Features

                                                      • Microscopic Features

                                                        CLINICAL ISSUES

                                                        • Presentation

                                                          • Demographics

                                                            • Natural History & Prognosis

                                                              • Treatment

                                                                DIAGNOSTIC CHECKLIST

                                                                • Image Interpretation Pearls

                                                                  Selected References

                                                                  1. Lev M et al: Sonographic appearances of torsion of the appendix testis and appendix epididymis in children. J Clin Ultrasound. 43(8):485-9, 2015
                                                                  2. Boettcher M et al: Differentiation of epididymitis and appendix testis torsion by clinical and ultrasound signs in children. Urology. 82(4):899-904, 2013
                                                                  3. Delaney LR et al: Ultrasound of the pediatric scrotum. Semin Ultrasound CT MR. 34(3):248-56, 2013
                                                                  4. Nicolay L et al: Torsion of the appendix testis in an undescended testis: a case report. Can J Urol. 20(3):6805-7, 2013
                                                                  5. Yusuf GT et al: A review of ultrasound imaging in scrotal emergencies. J Ultrasound. 16(4):171-8, 2013
                                                                  6. Sung EK et al: Sonography of the pediatric scrotum: emphasis on the Ts--torsion, trauma, and tumors. AJR Am J Roentgenol. 198(5):996-1003, 2012
                                                                  7. Park SJ et al: Sonography of intrascrotal appendage torsion: varying echogenicity of the torsed appendage according to the time from onset. J Ultrasound Med. 30(10):1391-6, 2011
                                                                  8. Singh AK et al: Torsion of testicular appendage. Pediatr Radiol. 40(3):373, 2010
                                                                  9. Artas H et al: Scrotal calculi. J Ultrasound Med. 26(12):1775-9, 2007
                                                                  10. Varga J et al: Acute scrotal pain in children--ten years' experience. Urol Int. 78(1):73-7, 2007
                                                                  11. Baldisserotto M et al: Color Doppler sonography of normal and torsed testicular appendages in children. AJR Am J Roentgenol. 184(4):1287-92, 2005
                                                                  12. Yang DM et al: Torsed appendix testis: gray scale and color Doppler sonographic findings compared with normal appendix testis. J Ultrasound Med. 24(1):87-91, 2005
                                                                  13. Ciftci AO et al: Clinical predictors for differential diagnosis of acute scrotum. Eur J Pediatr Surg. 14(5):333-8, 2004
                                                                  14. Adams BK et al: Tc-99m blood-pool imaging in torsion of an epididymal appendix. Clin Nucl Med. 28(6):526, 2003
                                                                  15. Sellars ME et al: Ultrasound appearances of the testicular appendages: pictorial review. Eur Radiol. 13(1):127-35, 2003
                                                                  16. McAndrew HF et al: The incidence and investigation of acute scrotal problems in children. Pediatr Surg Int. 18(5-6):435-7, 2002
                                                                  17. Johnson DB et al: Mullerian-type epithelial tumor arising within a torsed appendix testis. Urology. 54(3):561, 1999
                                                                  18. Monga M et al: Metachronous bilateral torsion of the testicular appendices. Int J Urol. 6(11):589-91, 1999
                                                                  19. Van Glabeke E et al: Acute scrotal pain in children: results of 543 surgical explorations. Pediatr Surg Int. 15(5-6):353-7, 1999
                                                                  20. Strauss S et al: Torsion of the testicular appendages: sonographic appearance. J Ultrasound Med. 16(3):189-92; quiz 193-4, 1997