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