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(1-3) Four testicular appendages, remnants of embryonic ducts, include the appendix testis, appendix epididymis, vas aberrans, and the paradidymis; 92% of males have an appendix testis, and 34% have an appendix epididymis.

Torsion of the appendix testis is the most common cause of scrotal pain in children.

Ultrasound of pediatric abdominal and scrotal emergencies

Several studies have contrasted physical examination findings associated with testicular torsion with findings related to epididymitis and torsion appendix testis. Neither the presence nor absence of any particular physical examination sign excludes the diagnosis of testicular torsion.

How useful is a physical exam in diagnosing testicular torsion?

Scrotal-inguinal hernia, testicular tumour, epididymoorchitis, torsion of the appendix testis, and testicular epididymal torsion should be considered in the differential diagnosis in the acute phase (10).

A Rare Cause of Scrotal Mass in a Newborn: Antenatal Intravaginal Testicular Torsion/Yenidoganda Nadir Bir Skrotal Kitle Nedeni: Antenatal Intravajinal Testis Torsiyonu

Effect of hydrocele on appendix testis in children.

A comparison of preoperative and postoperative testicular volume and blood flow in patients with inguinal hernia, hydrocele, and cord cyst: A prospective cohort study

The differential diagnoses of scrotal swelling and/or scrotal pain in a pediatric patient includes epididymo-orchitis, epididymitis, torsion of the appendix epididymis, torsion of the appendix testis, testicular tumor, scrotal soft tissue trauma, spermatic cord hematoma, scrotal cellulitis, inguinal hernia, hydrocele, varicocele, ureteral distention, lower back pain, peritonitis, and hematologic disorders, such as leukemia or lymphoma (Gordhan & Sadeghi-Nejad, 2015; Kadish & Bolte, 1998; Pepe et al., 2015; Sharp et al., 2013).

Testicular torsion: current evaluation and management