Torsion of Appendix Epididymis
This boy has an unusual, but significant physical finding: the blue dot sign.  The blue to purple discoloration seen in the picture on the left is caused by a torsed and ischemic appendix testis or appendix epididymis.  The blue dot sign is most easily visible within the first few hours following the torsion and it is more easily seen in fair skinned boys.

Torsion of an appendix testis or epididymis occurs when the 

Most boys with torsion of an appendix testis or appendix epididymis will not show the blue dot sign.  In many cases it may be impossible to distinguish between torsion of an appendix and torsion of the testis, a condition that requires prompt diagnosis and treatment in order to save the testis.  However, when the blue dot sign is seen and the testis is palpably normal, you can be confident that the boy has torsion of an appendix.  Analgesics will relieve the pain and imaging studies or surgery are not required.

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See Abnormal Development of the Testis/Scrotum.

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©David A. Hatch, M.D., 1996