Torsion of the appendix testis

Rakhee Gawande, Heike E. Daldrup-Link, Beverley Newman

Research output: Chapter in Book/Report/Conference proceedingChapter


Imaging description A longitudinal ultrasound of the right scrotum (Fig. 73.1) in a 13-year-old boy with gradual onset of testicular pain demonstrates a well-defined oval hypoechoic avascular structure located in the groove between the testis and epididymis. There was mild hyperemia of the testis and epididymis, which were otherwise normal in appearance. A moderate hydrocele and scrotal wall edema was also noted. These findings were suggestive of torsion of the appendix testis. Importance. Testicular appendages are remnants of embryonic mesonephric and paramesonephric ducts and consist of vascularized connective tissue. Five types of appendages have been identified. The appendix testis is a tiny structure, 1–7 mm in size, located at the upper pole of the testis, in the groove between the testis and epididymis. It has similar echogenicity to the testis and may be oval or sessile and less commonly pedunculated. It is present in 92% of patients and is the commonest appendage to undergo torsion. The appendix epididymis is located at the head of the epididymis, is commonly pedunculated, and is less frequently seen on ultrasound. The other appendages are difficult to identify on ultrasound imaging.

Original languageEnglish (US)
Title of host publicationPearls and Pitfalls in Pediatric Imaging
Subtitle of host publicationVariants and Other Difficult Diagnoses
PublisherCambridge University Press
Number of pages4
ISBN (Electronic)9781139084239
ISBN (Print)9781107017498
StatePublished - Jan 1 2012

Bibliographical note

Publisher Copyright:
© Heike Daldrup-Link and Beverley Newman 2014.


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