Torsion of the testicular appendage. Sonographic diagnosis

Torsion of the testicular appendages may simulate the clinical and physical examination findings of testicular torsion. Real-time imaging and duplex Doppler scanning aided the diagnosis of this entity in three children. The testes appear normal on sonograms and have normal vascular flow. A circular mass of increased echogenicity with a variably sized central hypoechoic region is seen adjacent to the testicle. We could not relate variations in echogenicity to time delay between clinical pain and sonographic examination.