These are tendon xanthomas. The causes for this include a lipid disorder such as hypercholesterolemia, and liver failure as in primary biliary cirrhosis. The diagnosis in children is made by the presence of two features out of the seven described. Torsion of the left testis. The discoloration and typical symptoms are sufficient to make the diagnosis.
Surgical exploration is essential to salvage the torted testis before it becomes gangrenous.
Pre-operatively, Color Doppler ultrasound can be used to make a positive diagnosis of torsion.