Which sign is most characteristic of torsion of the testicular appendix?

Which sign is most characteristic of torsion of the testicular appendix?

• A. Blue dot sign
• B. Elevated WBC
• C. Positive Prehn sign
• D. Cremaster reflex present

Answer: (D)

Torsion of the testicular appendix involves twisting a small vestigial structure near the testis, not the spermatic cord itself. Because the main nerve pathways to the cremaster muscle are not affected, the cremasteric reflex is typically preserved. This preserved reflex helps distinguish appendix testis torsion from true testicular torsion, where the reflex is often absent due to involvement of the cord’s nerves and vessels. While a blue dot sign on the scrotal skin can be seen in appendix torsion, it isn’t always present, so the intact cremasteric reflex is the most useful distinguishing sign in this condition.

Torsion of the testicular appendix involves twisting a small vestigial structure near the testis, not the spermatic cord itself. Because the main nerve pathways to the cremaster muscle are not affected, the cremasteric reflex is typically preserved. This preserved reflex helps distinguish appendix testis torsion from true testicular torsion, where the reflex is often absent due to involvement of the cord’s nerves and vessels. While a blue dot sign on the scrotal skin can be seen in appendix torsion, it isn’t always present, so the intact cremasteric reflex is the most useful distinguishing sign in this condition.