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testicular torsion
see scrotal pain/mass
Pathology:
- occurs when the testes twist on the spermatic cord
- testicular ischemia
Clinical manifestations:
- acute unilateral several scrotal pain with swelling
- overlying scrotal skin may be erythematous & warm
- presents acutely with nausea & vomiting [1]
- high-riding testicle, transversely oriented
- pain worsening with manual elevation*
- ipsilateral absent cremasteric reflex [1]
* contrast with epididymitis
Special laboratory:
- doppler ultrasonography to assess blood flow
- not necessary for patients with supportive history & unequivocal physical examination findings (ipsilateral absence of cremasteric reflex)
- surgery should not be delayed to obtain imaging
Management:
- surgical emergency
- reduction of testicular torsion, orchidopexy
- surgical reduction within 6 hours [1]
Related
testis
General
scrotal pain/mass (testicular pain, testicular torsion)
References
- Medical Knowledge Self Assessment Program (MKSAP) 17, 18, 19.
American College of Physicians, Philadelphia 2015, 2018, 2022.
- Bourke MM, Silverberg JZ.
Acute Scrotal Emergencies.
Emerg Med Clin North Am. 2019 Nov;37(4):593-610
PMID: 31563197