Patient selection: pediatric male with acute scrotum
Evaluation: clinical exam and scrotal ultrasonography (US)
Parameters:
(1) dysuria
(2) blue dot sign (subcutaneous blue dot)
(3) painful epididymis
|
Dysuria
|
Blue Dot
|
Painful Epididymis
|
Diagnosis
|
|
present
|
NA
|
NA
|
epididymitis
|
|
absent
|
present
|
NA
|
appendix testis torsion
|
|
absent
|
absent
|
present
|
epididymitis
|
|
absent
|
absent
|
absent
|
appendix testis torsion
|
where:
• In Figure 2 the node for painful epididymis has 2 branches both to appendix testis torsion. In Tables 1 and 2 painful epididymis favors epididymitis.
Ultrasound findings favoring epididymitis:
(1) increased peritesticular perfusion
(2) altered peritesticular echogenicity
(3) altered scrotal echogenicity
Additional findings favoring epididymis:
(1) fever > 38.5°C
(2) scrotal erythema
Ultrasound findings favoring appendix testis torsion:
(1) visualization of nodule at appendix testis
