Based on the ultrasound and physical exam findings, the diagnosis of torsion of the appendix testis
These ducts disappear in males, while vestigial vagina masculina and the appendix testis
are the remnants.
Another more common painful condition is torsion of the appendix testis
, a tiny structure that comes off the testis; this condition can usually be managed conservatively with non-steroidal anti-inflammatory medications and rest.
Clinical categorization of scrotal masses according to anatomic location and clinical findings Testicular Testicular Extratesticular Extratesticular painful masses painless painful masses painless masses masses Torsion of Malignant Epididymitis Hernia spermatic cord testicular tumors Orchitis Benign Torsion of Hydrocele, testicular appendix testis
hematocele tumors Testicular trauma In utero Torsion of Adenomatoid (rupture, extravaginal epididymis epididymis hematoma) torsion tumor Hemorrage into Incarcerated Soft tissue tumor hernia tumors Benign or malignant Kawasaki disease Idiopathic scrotal edema Henoch-Schonlein purpura
Possible differential diagnoses include not only torsion of the spermatic cord, but also torsion of the appendix testis
, torsion of the appendix epididymis, epididymitis/epididymo-orchitis, and inguinal hernia / communicating hydrocele.
There is some thought that torsion of the appendix testis
may be misdiagnosed as epididymitis on ultrasound because inflammation surrounding the ischemic appendage may mimic the focal hyperaemia seen with true epididymitis.
One patient (case 4) presented with pain of the appendix testis
pain which went on for several months.
Because the treatment for torsion is surgical, it is important to distinguish this from other etiologies of scrotal pain, such as orchitis, epidydimitis, torsion of the appendix testis
, and testicular trauma.