Q1 :
A14-year-old boy presents with sudden onset of pain and swelling of his right testicle. There was no history of trauma, he is not sexually active, and denies any history of penile discharge. On examination, the scrotum is swollen and tender. The cremasteric reflex is absent. A testicular flow scan shows a “cold spot” or
absent flow to the affected side. Which of the following is the most likely cause?
(A) inguinal hernia
(B) hydrocele
(C) epididymitis
(D) testicular torsion
(E) torsion of the appendix testis
Answer :
(D)
Testicular torsion is the most common cause of testicular pain in boys 12 years and older and is uncommon in those under 10 years. It may be sometimes related to trauma or injury but may occur spontaneously. If not diagnosed early, loss of blood flow to the testicle may result in permanent loss of testicularfunction.
Torsion of the testicular appendix usually occurs between the ages of 2 and 11 years. The testicular appendix is a vestigial stalk at the upper pole of the testis. Torsion results in pain and swelling of the scrotum, but
the onset of pain is more gradual. There is a 3- to 5-mm indurated, tender mass at the upper pole of the testis. It may sometimes be visible as
a “blue-dot.” Testicular scan may be helpful when this cannot be clinically differentiated from testicular torsion. A hydrocele is a painless collection of fluid in the tunica vaginalis.
Transillumination confirms that the mass is filled with fluid. Hydroceles are present in 1–2% of male newborns and usually resolve by age 1 year. In older boys, a communicating hydrocele may be associated with an inguinal hernia. Inguinal hernias usually appear as a bulge in the inguinal area extending into the scrotum. Hernias are painless, and are more noticeable during crying or straining. They are painful only when strangulated or incarcerated. Epididymitis is an acute inflammation of the epididymis, and is more common in sexually active adolescents. Urinalysis showspyuria and the etiology may be gonococcus or chlamydia but is often undetermined.
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