A 9-year-old boy presents with acute right scrotal pain of 8 hours duration. Examination reveals a tender pea-sized nodule at the upper pole of the testis with a bluish discoloration visible through the scrotal skin, and the cremasteric reflex is present. What is the most likely diagnosis?
- A Torsion of the appendix testis, managed conservatively ✓
- B Testicular torsion requiring emergency exploration
- C Epididymo-orchitis requiring intravenous antibiotics
- D Strangulated indirect inguinal hernia
Correct answer: A. Torsion of the appendix testis, managed conservatively
Explanation
The blue dot sign, a tender nodule at the upper pole with bluish discoloration through thin prepubertal scrotal skin, is pathognomonic for torsion of the appendix testis, a remnant of the paramesonephric duct. B preserved cremasteric reflex supports this over testicular torsion, where the reflex is usually lost and the whole testis is exquisitely tender. Management is analgesia and rest with spontaneous resolution in 7 to 10 days, unlike testicular torsion which demands urgent exploration.
Reference: Campbell-Walsh Urology, 12th ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
Written and medically reviewed by the StethoPrep medical team.