Diagnostic approach to nontraumatic scrotal pain in children and adolescents

IgA: immunoglobulin A; HSP: Henoch-Schönlein purpura.

* Experienced clinicians may attempt manual detorsion under sedation while awaiting arrival of a surgeon with pediatric urology expertise. Neonatal testicular torsion may present with testicular swelling since birth that may be tender or nontender. Refer to UpToDate topics on testicular torsion in children and neonatal torsion.

¶ Experienced clinicians may attempt manual reduction while awaiting arrival of a surgeon with pediatric urology expertise. Refer to UpToDate topics on inguinal hernia in children.

Δ Urinalysis and other ultrasound findings provide further diagnostic guidance. Refer to UpToDate topics on causes of pediatric testicular pain.

◊ In patients with IgA vasculitis, palpable purpura without thrombocytopenia or coagulopathy is the most common presenting feature. Other findings include joint pain, abdominal pain, and renal disease. Refer to UpToDate topics on IgA vasculitis (Henoch-Schönlein purpura).

§ In addition to rash, patients with Kawasaki disease typically have 3 or more of the following: high fever of >4 days duration, bilateral bulbar conjunctival injection with perilimbic swelling, oral mucous membrane changes, peripheral extremity changes (eg, erythema of the palms and soles and/or swelling of the hands and feet), or cervical lymphadenopathy with at least one node >1.5 cm in diameter. Refer to UpToDate topics on Kawasaki disease.