Scrotal ultrasonography of an 85-year-old man with hydrocele, making the appendix of the testicle clearly distinctive as a 4 mm outpouching at upper left in image. Doppler shows some blood flow.
The appendix of testis can, occasionally become twisted, causing acute one-sided testicular pain and may require surgical excision to achieve relief. One third of patients present with a palpable "blue dot" discoloration on the scrotum. This is nearly diagnostic of this condition. If clinical suspicion is high for the serious differential diagnosis of testicular torsion, a surgical exploration of the scrotum is warranted. Torsion of the appendix of testis occurs at ages 0–15 years, with a mean at 10 years, which is similar to that of testicular torsion.[1]