Skip to Main Content

eFigure 13-1

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).

eFigure 13–2

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

eFigure 13–3

Algorithm for differential diagnosis and treatment of fever with petechiae/purpura. (Adapted from http://www.rch.org.au/clinicalguide/cpg.cfm?doc_id=5270.)

eFigure 13–4

Differential diagnosis of scrotal swelling.

Favorite Table | Download (.pdf) | Print

Testicular Torsion

Epididymitis

Torsion of Testicular Appendage

Age group

Neonatal, 12–28 yo (66%)

Sexually active adolescents

7–14 yo

Onset

Sudden

Gradual

Gradual/sudden

Testicular lie

High

Low

Low

Cremasteric reflex

Usually not present

Present

Present

Prehn's sign*

Negative

Positive

Variable

Urinalysis

Normal

+WBCs on UA

Normal

Presentation

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%)

Doppler ultrasonography

↓ or absent flow

Normal or ↑ flow in epididymis

Torsed appendage with ↓ flow but normal flow to testes

Treatment

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

Antibiotics

  • Prepubertal: Most commonly no antibiotics required; may consider Trimethoprim–sulfamethoxazole
  • Sexually active: Ceftriaxone + azithromycin/doxycycline

Scrotal support (briefs) NSAID

Resolves within 2–12 days

*Relief of pain with elevation of testicle.

Etiologic agents include coliform bacteria, viruses in prepubertal boys and Neisseria gonorrhea, Chlamydia in adolescents.

  • 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.

Favorite Table | Download (.pdf) | Print

% of non-traumatic causes

Fracture

2%

Overuse (soft tissue injury, muscular strain, Osgood-Schlatter's disese, hematoma of the thigh)

18%

Osteomyelitis

Other (appendicitis, PID, torsion constipation, etc.)

2%

Transient synovitis

40%

Legg-Calve-Perthes syndrome (avascular necrosis of the femoral head)

2%

Inflammation (rheumatologic: JRA, SLE, reactive arthritis or HSP)

Infection (skin, soft tissue, joint, septic arthritis)

3%

4%

Foreign body

Tumor

Toddler's fracture” (nondisplaced spiral fracture of the tibial shaft)

Trauma

1%

1%

...

Pop-up div Successfully Displayed

This div only appears when the trigger link is hovered over. Otherwise it is hidden from view.