All of the following are early clinical signs of testicular torsion except?

The presence of swelling and coldness in the affected testicle is not an early clinical sign of testicular torsion. In the case of testicular torsion, initial symptoms typically include sudden onset of severe pain, nausea, and vomiting.

The affected testicle may indeed be elevated due to the twisting of the spermatic cord, which can also result in the absence of the cremasteric reflex; both of these are recognized early signs of testicular torsion. The elevated position of the testicle occurs because the twisted spermatic cord pulls it upward, and the absence of the cremasteric reflex indicates that the reflex mechanism controlling the ascent and descent of the testis is impaired due to nerve involvement or ischemia.

In contrast, the presence of coldness and pronounced swelling would more likely indicate a later stage of torsion or a related complication, such as hemorrhagic infarction of the testis due to prolonged lack of blood supply. Coldness may suggest a loss of blood flow, which occurs after an extended period following torsion, rather than being a hallmark of the early presentation. Thus, this characteristic does not represent an early clinical indicator.