Metachronous bilateral torsion of the testicular appendices

Background: Torsion of the appendix testis is a common cause of scrotal pai n in children and a common cause for surgical exploration of the pediatric scrotum. The first case of metachronous bilateral torsion of the testicular appendices managed by a non-operative approach is reported. Methods/Results: A case report and a computer-assisted review of the litera ture are presented. Physical findings of a tender, mobile mass over the ant erior surface of the testis characterize the presentation. Doppler findings of normal blood flow to the testes with increased flow to the adjacent app endix testis can be utilized as an adjunct to diagnosis. Ultrasonographic f indings of a pedunculated mass with a central hypoechoic area at the superi or aspect of the testis support the diagnosis. Accurate non-operative diagn osis of torsion of the appendix testis permits successful conservative mana gement with non-steroidal anti-inflammatory agents. Conclusions: Improvements in ultrasonographic and Doppler imaging of torsio n of the appendix testis have facilitated the diagnosis of this entity and decreased the need for surgical exploration of the scrotum.