Torsion of a testicular appendage in an adult male
Spermatic Cord Torsion
Torsion of a testicular appendage is a self-limited process: with rest and analgesics, it resolves within one week. Clinically, the patient presents with a gradual onset of mild to moderate scrotal pain localized to the upper pole of the testis. Urinary symptoms are absent. The infarcted appendage may be seen through the thin scrotal skin; this ''blue dot'' sign is pathognomonic of the entity. It is not always possible, on clinical grounds alone, to distinguish torsion of an appendage from torsion of a testis; under these circumstances, radionuclide scrotal scintigraphy is a paramount diagnostic modality, rapidly and accurately separating those individuals who require surgical intervention from those in whom more conservative therapy will suffice. The radionuclide presentation of torsion of a testicular appendage is most often that of a normal scan, although mildly increased perfusion as well as photopenic defects have been reported. The case presented is unusual because of the patient's age (25 years old) and the striking scan appearance.