Thenewonsetofpain,swelling,and/ortendernessofintrascrotalcontentsisreferred

toasacutescrotumandisacommonpresenting
Etiology and Differential Diagnosis
Differential Diagnosis of Pediatric/Adolescent Acute Scrotal Pain
Individualswithmanytypesofinguinoscrotalpathologymaypresentwithacute
scrotalpainorswelling(Table1326).Insomepatientswithscrotalpathologythe
painmaybelocalizedtotheinguinalorabdominalregionsorpoorlylocalized,
particularlyinyoungerchildren.Historicalinformationofpotentialimportance
includestheonset,quality,duration,andconsistencyofpain;historyofprevious
episodes;exacerbationwithactivity;presence
Appendage torsion Appendix testis Other appendage (epididymis,
paradidymis, vas aberrans)
Spermatic cord torsion Intravaginal, acute or intermittent Extravaginal
Epididymitis Infectious
Urinary tract infection Sexually transmitted disease ?Viral
Sterile or traumatic Scrotal edema/erythema
Diaper dermatitis, insect bite, or other skin lesions Idiopathic scrotal edema
Early Fournier gangrene
Orchitis Associated with epididymitis with or without abscess Vasculitis (e.g.,
Henoch-Schnlein purpura) Viral illness (mumps)
Trauma With hematocele or scrotal contusion With testicular rupture
Hernia/hydrocele Inguinal hernia with or without incarceration Communicating
hydrocele Encysted hydrocele with or without torsion Associated with acute
abdominal pathology (e.g., appendicitis,
peritonitis, splenic rupture) Varicocele
With pain
With acute rupture or thrombosis Intrascrotal mass
Cystic dysplasia or tumor of testis Epididymal cyst/spermatocele or tumor
Other paratesticular tumors
Musculoskeletal pain due to inguinal tendonitis or muscle strain Referred pain
(e.g., ureteral calculus or anomaly
ofassociatedsymptomssuchasnausea,vomiting,irritativevoiding,peniledischarge,
fever,andotherillness;andtrauma,sexual,andimmunizationhistory.Inalarge
seriesofsurgicallytreatedpediatricpatients,appendixtestistorsionisthemost
commondiagnosis(40%to60%),followedbyspermaticcordtorsion(20%to30%
excludingneonates),epididymitis(5%to15%),andotherornopathology(~10%)
(AndersonandGiacomantonio,1985;Sidleretal,1997;VanGlabekeetal,1999;
Mushtaqetal,2003;Murphyetal,2006;Makelaetal,2007).Ingeneral,appendage
torsionismostcommonafterinfancyandbeforepubertywhereasepididymitisand
spermaticcordtorsionaremostcommonintheperinatalandpubertalperiods.
However,anyofthesediseasescanoccuratanytimeduringchildhoodand
adolescence.