Distinguishing conditions responsible for acute scrotal pain in adults

	Symptom onset	Pain location	Cremasteric reflex	Other clinical findings
Appendiceal torsion	Acute or subacute	Upper pole of testis	Positive	Blue dot sign
Epididymitis	Acute or chronic	Epididymis	Positive	Positive urinalysis, urine culture, or diagnostic tests for gonorrhea or Chlamydia infection
Fournier's gangrene	Acute	Diffuse	Positive	Tense edema outside of involved skin, blisters/bullae, crepitus, fever, rigors, hypotension
Testicular torsion	Acute	Testis	Negative	High-riding testis, bell clapper deformity, profound testicular swelling

Graphic 56026 Version 6.0

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