Epididymal appendix
Epididymal appendices, also known as appendix of the epididymis or appendix epididymis, are an testicular appendage found at the head of the epididymis . They represent a developmental remnant of the mesonephric duct (Wolffian duct). In 78% of the cases, it has a stalk configuration and is thus prone to torsion .
Clinical presentation
Normally, epididymal appendices are of no clinical significance, but when torsed they can cause an acute scrotum in children . After torsion of its pedicle with resultant infarction, the appendage may detach and wander inside the scrotum and appear as minute mobile particles ("loose bodies") .
Radiographic features
Ultrasound
Ultrasonography with a high-frequency linear transducer can reliably evaluate the appendix testis, including its vascularity. Its reported frequency in ultrasonography is ~12.5% (range 6-17%) .
The appendix epididymis, similarly to the appendix testis, is normally oval and pedunculated, although may be sessile in shape . They appear iso- or hyperechoic to the epididymal parenchyma. Sometimes, calcifications may be found. In general, the epididymis appendix is best seen when floating in a hydrocele.
Differential diagnosis
When torsed, it is a cause of acute scrotum and imaging differential diagnosis should include:
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