Testicular torsion

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[edit] Discussion of Testicular torsion

  • Testicular torsion implies first venous and later arterial flow obstruction.
  • The extent of testicular ischemia will depend on the degree of twisting (180°–720°) and the duration of the torsion.
  • Testicular salvage is more likely in patients treated within 4–6 hours after the onset of torsion.
  • A predisposing factor is the "bell clapper" deformity, in which the tunica vaginalis joins high on the spermatic cord, leaving the testis free to rotate.
  • Differentiation between testicular torsion and epididymo-orchitis is a clinical challenge, since scrotal pain, swelling, and redness or tenderness are clinical symptoms common to these two entities.

[edit] Imaging Findings for Testicular torsion

[edit] US

  • In the early phases of torsion (1–3 hours), testicular echogenicity appears normal.
  • With progression, enlargement of the affected testis and increased or heterogeneous echogenicity are common findings.
  • Sonographic evaluation of the spermatic cord is an essential part of the examination. The point of cord twisting can be identified at the external inguinal orifice. The intrascrotal portion of the edematous cord appears as a round, ovoid, or curled echogenic extratesticular mass, with the epididymal head wrapped around it.
  • A definitive diagnosis of complete testicular torsion is made when blood flow is visualized on the normal side but is absent on the affected side.
  • Incomplete torsion refers to cord twisting of less than 360°, in which some arterial flow persists in the affected testis.
  • Testicular viability can be suggested from gray-scale and color Doppler findings. Normal echogenicity with mild testicular enlargement is a good sign of viability, whereas marked enlargement, heterogeneous echotexture, and scrotal wall hypervascularity are signs of testicular infarction and necrosis.


[edit] Images

Patient #1:US images demonstrate right testicular torsion

[edit] See Also

[edit] External Links

[edit] References for Testicular torsion