Intended for healthcare professionals

Endgames Case Review

Acute left testicular pain in a child

BMJ 2024; 385 doi: (Published 25 April 2024) Cite this as: BMJ 2024;385:e077516
  1. Shin Yin Ooi, senior resident,
  2. Timothy Shao Ern Tan, associate consultant paediatric radiologist
  1. Department of Diagnostic and Interventional Imaging, KK Women’s and Children’s Hospital, Singapore
  1. Correspondence to: T S E Tan timothy.tan.shao.ern{at}

A 10 year old boy presented to the emergency department with a one day history of left testicular pain and swelling. He had no history of scrotal trauma, fever, nausea, abdominal pain, or urinary symptoms. Clinical examination showed a small, tender, palpable nodule at the upper pole of the left testis. Bilateral cremasteric reflexes were present and both testes showed a normal vertical lie. No appreciable changes were seen to the overlying skin of the scrotum. Urinalysis results were unremarkable. In view of persistent pain, urgent scrotal ultrasonography was performed for further evaluation (fig 1), which showed a small tender nodule between the left testis and epididymis. The sonographic features of both testes were otherwise normal.

Fig 1

Greyscale longitudinal/transverse (A) and colour Doppler ultrasonography (B) of the left testicular superior pole. A shows a subcentimetre nodule with heterogenous salt and pepper echotexture (arrow) situated in between the left testis and epididymis, which was tender during scanning, in keeping with a testicular appendage. B shows no vascularity within the nodule (arrow), worrisome for torsion


  1. What are the differential diagnoses?

  2. What is the most likely diagnosis?

  3. How would …

View Full Text

Log in

Log in through your institution


* For online subscription