Acute left testicular pain in a child

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.