In a child presenting with an acute painful scrotal swelling, the cremasteric reflex is absent, the testis lies high and horizontal (Brunzel sign), and Doppler shows absent flow to the affected testis. These findings are pathognomonic of:

• A Epididymo-orchitis
• B Torsion of the appendix testis
• C Testicular torsion ✓
• D Idiopathic scrotal oedema

Explanation

Testicular torsion presents with sudden severe scrotal pain, absent cremasteric reflex (most reliable clinical sign), high-riding horizontal testis (bell-clapper deformity) and absent Doppler flow. The Brunzel sign (horizontal lie) reflects the abnormal attachment of the tunica vaginalis. Absent cremasteric reflex distinguishes torsion from epididymo-orchitis (reflex intact). Surgery (orchidopexy or orchidectomy) must be performed within 6 hours to salvage the testis.

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

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.