Torsed Appendix Testis

Normal testis and epididymis with torsed appendage.

The appendix testis is a vestigial remnant of the Müllerian duct. It is a little nub of non functioning tissue that is normally located in the superior pole of the testicle. If this structure twists (torsion) it can lead to inflammation and pain. This process is most commonly seen in pediatrics especially prepubescent boys.

Clinically there will be pain, in some case epididymitis can develop. The normal appendage is not normally seen in routine scans, though it may reveal itself if there’s a hydrocele. There may also a “blue dot sign” which is a palpable, tender nodule that appears blue/purple under the skin on close inspection.

Torsed Appendix Testis
Torsed appendix testis
Torsed appendage with epididymitis

It is thought that once this tissue becomes necrotic it detaches from the tesis to be a freely moving object in the tunica vaginalis, it then undergoes calcification leading the o scrotal pearl (aka scrotolith).

Scrotal pearl

This is condition is self limiting and does not require surgery. It is typically treated with rest and analgesics/anti-inflammatory medication.

4 thoughts on “Torsed Appendix Testis

  1. Beautiful illustration of torsed appendix, does it mean that a lot of scrotal pearls that I see in adult patients is a result of above pathology


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