Testicular appendix
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- updated 6 Dec 2022:
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A testicular appendix (alternatively called appendix of testis or appendix testis, and historically also known as hydatid of Morgagni) represents a developmental remnant of the paramesonephric duct (Müllerian duct) which is situated in the upper pole of the testis inside a groove between the testis and the head of epididymis 1.
Epidemiology
The prevalence in childhood is around 85% (range 83-92%). The testicular appendix can be bilateral in 69% of the cases 4.
Clinical presentation
Testicular appendages in general alone have no clinical significance. However, when complicated by torsion, they can lead to acute scrotal pain 2.
Radiographic features
Ultrasound
Ultrasonography with high-frequency linear array transducers is the modality of choice in evaluating the evaluation of scrotum and testis with its appendages. It can quickly and easily demonstrate the existence of such anatomic structures, and their vascularity and without exposure to radiation.
Appendages of the testis are best seen when combined with hydrocele. The frequency of the ultrasonographic identification of these anatomic structures is around 89% 3.
The normal testicular appendix is seen as an oval, sessile structure in 88% of cases 4. Its length ranges from 1-7 to 7 mm 1. Colour Doppler ultrasonography can occasionally detect blood flow inside testicular appendages 4. When pedunculated, the appendix is in danger of torsion.
History and etymology
"Appendix testis" was first described by Giovanni Battista Morgagni (1682-1771) in his textbook 'De Sedibus et Causis Morborum per Anatomen Indagatis' (On the Seats and Causes of Diseases Investigated by Anatomy) in 1761 5.
Differential diagnosis
In cases of torsion, patients present with acute scrotal pain and imaging differential diagnosis includes:
Related pathology
-<p>A <strong>testicular appendix</strong> (alternatively called <strong>appendix of testis</strong> or <strong>appendix testis</strong>, and historically also known as <strong>hydatid of Morgagni</strong>) represents a developmental remnant of the paramesonephric duct (<a href="/articles/muellerian-duct">Müllerian duct</a>) which is situated in the upper pole of the testis inside a groove between the testis and the head of <a href="/articles/epididymis">epididymis</a> <sup>1</sup>.</p><h4>Epidemiology</h4><p>The prevalence in childhood is around 85% (range 83-92%). The testicular appendix can be bilateral in 69% of the cases <sup>4</sup>.</p><h4>Clinical presentation</h4><p><a href="/articles/testicular-appendages">Testicular appendages</a> in general alone have no clinical significance. However, when complicated by torsion, they can lead to acute scrotal pain <sup>2</sup>.</p><h4>Radiographic features</h4><h5>Ultrasound</h5><p>Ultrasonography with high-frequency linear array transducers is the modality of choice in the evaluation of scrotum and testis with its appendages. It can quickly and easily demonstrate the existence of such anatomic structures, their vascularity and without exposure to radiation. Appendages of the testis are best seen when combined with <a href="/articles/hydrocele-2">hydrocele</a>. The frequency of the ultrasonographic identification of these anatomic structures is around 89% <sup>3</sup>.</p><p>The normal testicular appendix is seen as an oval, sessile structure in 88% of cases <sup>4</sup>. Its length ranges from 1-7 mm <sup>1</sup>. Colour Doppler ultrasonography can occasionally detect blood flow inside testicular appendages <sup>4</sup>. When pedunculated, the appendix is in danger of <a href="/articles/torsion-of-the-appendix-testis">torsion</a>.</p><h4>History and etymology</h4><p>"Appendix testis" was first described by Giovanni Battista Morgagni (1682-1771) in his textbook 'De Sedibus et Causis Morborum per Anatomen Indagatis' (On the Seats and Causes of Diseases Investigated by Anatomy) in 1761 <sup>5</sup>.</p><h4>Differential diagnosis</h4><p>In cases of <a href="/articles/torsion-of-the-appendix-testis">torsion</a>, patients present with acute scrotal pain and imaging differential diagnosis includes:</p><ul>- +<p>A <strong>testicular appendix</strong> (alternatively called <strong>appendix of testis</strong> or <strong>appendix testis</strong>, and historically also known as <strong>hydatid of Morgagni</strong>) represents a developmental remnant of the paramesonephric duct (<a href="/articles/muellerian-duct">Müllerian duct</a>) which is situated in the upper pole of the testis inside a groove between the testis and the head of <a href="/articles/epididymis">epididymis</a> <sup>1</sup>.</p><h4>Epidemiology</h4><p>The prevalence in childhood is around 85% (range 83-92%). The testicular appendix can be bilateral in 69% of the cases <sup>4</sup>.</p><h4>Clinical presentation</h4><p><a href="/articles/testicular-appendages">Testicular appendages</a> in general alone have no clinical significance. However, when complicated by torsion, they can lead to acute scrotal pain <sup>2</sup>.</p><h4>Radiographic features</h4><h5>Ultrasound</h5><p>Ultrasonography with high-frequency linear array transducers is the modality of choice in evaluating the scrotum and testis with its appendages. It can quickly and easily demonstrate the existence of such anatomic structures and their vascularity without exposure to radiation. </p><p>Appendages of the testis are best seen when combined with <a href="/articles/hydrocele-2">hydrocele</a>. The frequency of the ultrasonographic identification of these anatomic structures is around 89% <sup>3</sup>.</p><p>The normal testicular appendix is seen as an oval, sessile structure in 88% of cases <sup>4</sup>. Its length ranges from 1 to 7 mm <sup>1</sup>. Colour Doppler ultrasonography can occasionally detect blood flow inside testicular appendages <sup>4</sup>. When pedunculated, the appendix is in danger of <a href="/articles/torsion-of-the-appendix-testis">torsion</a>.</p><h4>History and etymology</h4><p>"Appendix testis" was first described by Giovanni Battista Morgagni (1682-1771) in his textbook 'De Sedibus et Causis Morborum per Anatomen Indagatis' (On the Seats and Causes of Diseases Investigated by Anatomy) in 1761 <sup>5</sup>.</p><h4>Differential diagnosis</h4><p>In cases of <a href="/articles/torsion-of-the-appendix-testis">torsion</a>, patients present with acute scrotal pain and imaging differential diagnosis includes:</p><ul>
References changed:
- 1. Sellars M & Sidhu P. Ultrasound Appearances of the Testicular Appendages: Pictorial Review. Eur Radiol. 2003;13(1):127-35. <a href="https://doi.org/10.1007/s00330-002-1387-1">doi:10.1007/s00330-002-1387-1</a> - <a href="https://www.ncbi.nlm.nih.gov/pubmed/12541120">Pubmed</a>
- 2. Valentino M, Bertolotto M, Ruggirello M, Pavlica P, Barozzi L, Rossi C. Cystic Lesions and Scrotal Fluid Collections in Adults: Ultrasound Findings. J Ultrasound. 2011;14(4):208-15. <a href="https://doi.org/10.1016/j.jus.2011.10.008">doi:10.1016/j.jus.2011.10.008</a> - <a href="https://www.ncbi.nlm.nih.gov/pubmed/23396379">Pubmed</a>
- 3. Johnson K & Dewbury K. Ultrasound Imaging of the Appendix Testis and Appendix Epididymis. Clin Radiol. 1996;51(5):335-7. <a href="https://doi.org/10.1016/s0009-9260(96)80110-3">doi:10.1016/s0009-9260(96)80110-3</a> - <a href="https://www.ncbi.nlm.nih.gov/pubmed/8641095">Pubmed</a>
- 4. Baldisserotto M, de Souza J, Pertence A, Dora M. Color Doppler Sonography of Normal and Torsed Testicular Appendages in Children. AJR Am J Roentgenol. 2005;184(4):1287-92. <a href="https://doi.org/10.2214/ajr.184.4.01841287">doi:10.2214/ajr.184.4.01841287</a> - <a href="https://www.ncbi.nlm.nih.gov/pubmed/15788612">Pubmed</a>
- 1. Sellars ME, Sidhu PS. Ultrasound appearances of the testicular appendages: pictorial review. Eur Radiol. 2003;13 (1): 127-35. <a href="http://dx.doi.org/10.1007/s00330-002-1387-1">doi:10.1007/s00330-002-1387-1</a> - <a href="http://www.ncbi.nlm.nih.gov/pubmed/12541120">Pubmed citation</a><span class="auto"></span>
- 2. Valentino M, Bertolotto M, Ruggirello M et-al. Cystic lesions and scrotal fluid collections in adults: Ultrasound findings. J Ultrasound. 2011;14 (4): 208-15. <a href="http://dx.doi.org/10.1016/j.jus.2011.10.008">doi:10.1016/j.jus.2011.10.008</a> - <a href="http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3558078">Free text at pubmed</a> - <a href="http://www.ncbi.nlm.nih.gov/pubmed/23396379">Pubmed citation</a><span class="auto"></span>
- 3. Johnson KA, Dewbury KC. Ultrasound imaging of the appendix testis and appendix epididymis. Clin Radiol. 1996;51 (5): 335-7. <a href="http://www.ncbi.nlm.nih.gov/pubmed/8641095">Pubmed citation</a><span class="auto"></span>
- 4. Baldisserotto M, de Souza JC, Pertence AP et-al. Color Doppler sonography of normal and torsed testicular appendages in children. AJR Am J Roentgenol. 2005;184 (4): 1287-92. <a href="http://dx.doi.org/10.2214/ajr.184.4.01841287">doi:10.2214/ajr.184.4.01841287</a> - <a href="http://www.ncbi.nlm.nih.gov/pubmed/15788612">Pubmed citation</a><span class="auto"></span>
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