Duplex sonographic findings in children with torsion of the testicular appendages: overlap with epididymitis and epididymoorchitis

Abstract Background and Purpose Torsion of the testicular appendages (TTA) is the most common cause of acute scrotum in children, and yet there are only few dedicated studies of the imaging findings. Objective To review our experience with the use of duplex sonography in children with TTA and to evaluate if sonography can successfully distinguish TTA from epididymoorchitis. Methods We reviewed the medical files and imaging findings of 29 children aged 0.7 to 13.9 years (mean, 6.5 years) with a diagnosis of TTA based on testicular exploration who were evaluated preoperatively with duplex sonography. Results A tender upper pole nodule, the typical sign of TTA, was palpated in only 2 (6.9%) children. Duplex sonography demonstrated an extratesticular upper pole nodule in 9 (31%) children. Secondary inflammatory changes included hydrocele in 22 (75.9%), enlarged epididymis in 22 (75.9%), scrotal wall edema in 16 (55.2%), and swollen testis in 9 (31%) children. Fourteen (48%) children had inflammatory changes with no evidence of an extratesticular nodule. Conclusion Duplex sonography findings of secondary inflammatory changes in the absence of evidence of an extratesticular nodule may suggest an erroneous diagnosis of epididymitis or epididymoorchitis in children with TTA.