الكتلة المؤلمة في الصفن Painful Scrotal Mass

Torsion of testis

rotation of spermatic cord producing ischemia of testis.

Stedman's Medical Dictionary 5.0

ACUTELY PAINFUL SCROTUM
Causes of an acutely painful enlarged scrotum in a child include:
● trauma
● testicular torsion
● torsion of the appendix testis
● epididymitis
● epididymo-orchitis
● acute hydrocele
● incarcerated hernia
● tumor
● vasculitis
● idiopathic scrotal edema.
The main clinical dilemma of a child presenting with an acutely painful swollen testis is a distinction between testicular torsion and acute epididymoorchitis.
Clinically this can be difficult to diagnose in over half of the patients, as fever and pyuria may occur in both. The painful scrotal mass is a surgical emergency and is considered to be testicular torsion until proven therwise. It is surgical dictum that surgery has to take place within 24 hours of the onset of symptoms if the testis is to remain viable and saved.

Arce JD, Cortes M, Vargas JC. Sonographic diagnosis of acute spermatic cord torsion. Rotation of the cord: a key to the diagnosis. Pediatr Radiol 2002 .