Diagnostic Ultrasound - Abdomen and Pelvis

Testicular Torsion/Infarction
Diagnoses: Scrotum
TERMINOLOGY
• Spontaneous or traumatic twisting of testis & spermatic
cord within scrotum, resulting in vascular
occlusion/infarction
IMAGING
• Absent or decreased abnormal testicular blood flow on
color Doppler US
• Findings vary with duration and degree of rotation of cord
• Unilateral in 95% of patients
• Role of spectral Doppler is limited; may be helpful to detect
partial torsion; in partial torsion of 360° or less, spectral
Doppler may show diminished diastolic arterial flow
• Spiral twist of spermatic cord cranial to testis and
epididymis causing torsion knot or whirlpool pattern of
concentric layers
KEY FACTS
PATHOLOGY
• Varying degrees of ischemic necrosis & fibrosis depending
on duration of symptoms
• Undescended testes have an increased risk of torsion
• Intravaginal torsion: Common type, most frequently occurs
at puberty
CLINICAL ISSUES
• Acute scrotal/inguinal pain; swollen, erythematous
hemiscrotum without recognized trauma
• Reducing time lag between onset of symptoms and time of
surgical or manual detorsion is of utmost importance in
preserving viable testis
• Nonviable testicle usually removed; higher risk of
subsequent torsion on contralateral side
• Venous obstruction occurs 1st, followed by obstruction of
arterial flow, which leads to testicular ischemia
(Left) Graphic shows spiral
twist st of the spermatic cord
with torsion, leading to venous
congestion and compromised
blood supply to the testis ſt.
(Right) Sagittal power Doppler
ultrasound of the left testis in
a young male with
intermittent symptoms of left
testicular pain demonstrates a
large focal avascular
heterogeneous area
consistent with infarct that is
likely secondary to
intermittent torsion.
(Left) Transverse color
Doppler ultrasound of the
testis in a young male with an
acute painful scrotum for 48
hours shows a heterogeneous
avascular testis with cystic
areas st, consistent with an
infarcted testis with necrosis
secondary to torsion. (Right)
Sagittal color Doppler
ultrasound superior to the left
testis in a young male with
acute painful scrotum shows a
whirlpool sign secondary to
a twisted spermatic cord.
Patient was manually
detorsed followed by bilateral
orchidopexy.
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