A 10-year-old boy presents with sudden right scrotal pain of 6 hours duration. The testis itself is only mildly tender. At the upper pole of the testis a small, exquisitely tender firm nodule is felt, with a bluish discoloration visible through the overlying scrotal skin. The cremasteric reflex is present. What is the most likely diagnosis?
- A Testicular torsion
- B Torsion of the appendix testis ✓
- C Epididymo-orchitis
- D Strangulated indirect inguinal hernia
Correct answer: B. Torsion of the appendix testis
Explanation
The blue dot sign, a tender nodule at the upper pole of the testis with bluish discoloration through thin scrotal skin, is pathognomonic for torsion of the appendix testis, a vestigial remnant of the paramesonephric duct. It peaks around 7 to 12 years of age and is managed conservatively with analgesia, unlike testicular torsion, which needs emergency exploration. A preserved cremasteric reflex and a normal-position testis also argue against spermatic cord torsion.
Reference: Bailey and Love's Short Practice of Surgery, 28th ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
Written and medically reviewed by the StethoPrep medical team.