Torsion of the testicular appendix
Acute right scrotal pain.
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The right epididymis is seen enlarged in size with a fairly well defined 8 x 7 x 6 mm heterogeneously hypoechoic lesion noted within its vicinity with no detected vascularity. Both testes are of normal size and symmetrical with homogenous texture to their parenchyma. No focal lesions and intact regular capsules. No peri-testicular masses or fluid collections. Normal size and echogenicity of the left epididymis. Colour flow mapping of the scrotal veins shows no visible dilated veins of the pampiniform plexuses, the spermatic cord or peri-testicular region. No venous reflux occurs during Valsalva's manoeuvre.
Torsion of the appendix testis was confirmed intra-operatively.
An enlarged epididymis with a small hypoechoic avascular lesion adjacent to the testis is highly suggestive of torsion of appendix testis in a child with sudden onset of acute painful hemiscrotum.