Algorithm for the management of fever without localizing source in patients 0 to 2 months of age. (Adapted from Texas Children's Hospital: Evidenced based clinical guideline on fever without localizing signs 0–60 days old).
Algorithm for the management of fever without localizing signs in patients 2 to 36 months of age. (Adapted from Texas Children's Hospital: Evidenced based clinical guideline on fever without localizing signs in 2–36 mo.)
Comparison of Testicular Torsion, Epididymitis, and Torsion of Testicular Appendage
Differential diagnosis of scrotal swelling.
Torsion of Testicular Appendage
Neonatal, 12–28 yo (66%)
Sexually active adolescents
Usually not present
+WBCs on UA
Acute onset of pain, nausea/vomiting, purple, swollen, painful testes
Fever, chills, urethral discharge, nausea, neonatal, 12–28 yo (66%), edematous and tender epididymis
Pain located in the superior pole of testicle; mild erythema or edema; blue dot sign (21%)
↓ or absent flow
Normal or ↑ flow in epididymis
Torsed appendage with ↓ flow but normal flow to testes
Emergency surgery: Bilateral fixation of testes (irreversible damage possible in 5–6 h)
Manual detorsion (open book technique) if timely surgical intervention not available
Scrotal support (briefs), NSAIDs
- Prepubertal: Most commonly no antibiotics required; may consider Trimethoprim–sulfamethoxazole
- Sexually active: Ceftriaxone + azithromycin/doxycycline
Scrotal support (briefs) NSAID
Resolves within 2–12 days
- Definition: Uneven alteration in natural gait (secondary to pain, weakness, deformity).
- Etiology: Trauma is the most common cause of limp. See the table below for causes of limp when there is no history of trauma.
% of non-traumatic causes
Overuse (soft tissue injury, muscular strain, Osgood-Schlatter's disese, hematoma of the thigh)
Other (appendicitis, PID, torsion constipation, etc.)
Legg-Calve-Perthes syndrome (avascular necrosis of the femoral head)
Inflammation (rheumatologic: JRA, SLE, reactive arthritis or HSP)
Infection (skin, soft tissue, joint, septic arthritis)
“Toddler's fracture” (nondisplaced spiral fracture of the tibial shaft)