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Torsion of appendix testis — RACP Paediatrics MCQ

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ModerateEmergencyTorsion of appendix testisRACP Paediatrics

A 9-year-old presents with gradual onset mild scrotal pain. Examination reveals a small tender nodule palpable at the upper pole of the testis with a 'blue dot' sign visible through the scrotal skin. The testis itself is non-tender and lies normally. Cremasteric reflex is present. What is the most likely diagnosis?

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Correct answer: A — Torsion of the appendix testis

Gradual onset mild scrotal pain with a tender nodule at the upper pole of the testis showing a 'blue dot' sign (infarcted appendix testis visible through the skin) with a normal-lying testis and present cremasteric reflex is torsion of the appendix testis. This is managed conservatively with analgesia and rest. It is the most common cause of acute scrotal pain in prepubertal boys.

Reference: RCH Melbourne – 2023 – Acute Scrotal Pain CPG; RACP Paediatric Curriculum – Emergency