Differential diagnosis of pediatric acute scrotum

• Testicle torsion
• Torsion of the appendix testis
• Epididimo-orchitis
• Inguinal hernia
• Hydrocele
• Testicle tumor
• Testicle trauma

Approach to the differential diagnosis of the acute scrotum:

• Ultrasound is the primary modality in the assessment of the acute scrotum
• Testicle torsion is diagnosed by the absence of arterial blood flow via color and spectral doppler US in the testicle
• Torsion of the appendix testis is most often a clinical diagnosis (blue dot on scrotum) and is diagnosed by the absence of arterial blood flow via color and spectral doppler US in the appendix testis
• Epididimo-orchitis is diagnosed by increased arterial blood flow to the epididymis and or testicle by color doppler US
• Inguinal hernia is diagnosed when bowel loops are seen in the scrotum
• Hydrocele is diagnosed when anechoic fluid is seen in the scrotum
• Testicle tumor is an intratesticular mass
• Testicle trauma has a variable appearance in the right clinical setting