title: Metachronous bilateral torsion of the testicular appendices.
abstract: BACKGROUND
  Torsion of the appendix testis is a common cause of scrotal pain in children and a common cause for surgical exploration of the pediatric scrotum. The first case of metachronous bilateral torsion of the testicular appendices managed by a non-operative approach is reported.
  
  
  RESULTS
  A case report and a computer-assisted review of the literature are presented. Physical findings of a tender, mobile mass over the anterior surface of the testis characterize the presentation. Doppler findings of normal blood flow to the testes with increased flow to the adjacent appendix testis can be utilized as an adjunct to diagnosis. Ultrasonographic findings of a pedunculated mass with a central hypoechoic area at the superior aspect of the testis support the diagnosis. Accurate non-operative diagnosis of torsion of the appendix testis permits successful conservative management with non-steroidal anti-inflammatory agents.
  
  
  CONCLUSIONS
  Improvements in ultrasonographic and Doppler imaging of torsion of the appendix testis have facilitated the diagnosis of this entity and decreased the need for surgical exploration of the scrotum.
authors.affiliation: Department of Urology, University of California, San Diego 92103-8897, USA. mmonga@ucsd.edu
authors.forename: M
authors.initials: M
authors.lastname: Monga
authors.forename: H M
authors.initials: HM
authors.lastname: Scarpero
authors.forename: J
authors.initials: J
authors.lastname: Ortenberg
mesh_terms: D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000627:therapeutic use; D002648:Child; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D011877:Radionuclide Imaging; D013086:Spermatic Cord Torsion / Q000000981:diagnostic imaging* / Q000628:therapy; D016896:Treatment Outcome; D018608:Ultrasonography, Doppler
chemical_list: D000894:Anti-Inflammatory Agents, Non-Steroidal