An 8-year-old boy presents with acute right scrotal pain of 6 hours duration. The testis is normal in position and not particularly tender. A small, firm, exquisitely tender nodule is felt at the upper pole of the testis, with a bluish discoloration visible through the overlying skin. Urinalysis is normal. The most likely diagnosis is:

• A Testicular torsion requiring immediate exploration
• B Strangulated indirect inguinal hernia
• C Epididymo-orchitis requiring antibiotics
• D Torsion of the appendix testis, managed conservatively ✓

Explanation

The blue dot sign, a tender infarcted nodule at the upper pole of the testis with bluish discolouration through the skin, is pathognomonic of torsion of the appendix testis, a vestigial remnant of the mesonephric duct. It typically affects boys aged 7 to 12 years and is managed conservatively with analgesia and rest, resolving over 1 to 2 weeks. In testicular torsion the whole testis is swollen, high riding, and exquisitely tender, and exploration within 6 hours is mandatory. Epididymo-orchitis shows urinary symptoms and a tender epididymis.

Reference: Bailey and Love's Short Practice of Surgery, 27th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.