Ultrasound of Testicular Torsion

In this radiology lecture, we review the ultrasound appearance of testicular torsion through three unique cases.

Key teaching points include:

Torsion occurs when spermatic cord twists and cuts off blood supply to the testis.
Bell-clapper deformity most common etiology: Abnormally high attachment of tunica vaginalis allowing spermatic cord rotation and testicular torsion (intravaginal).
Torsion has a bimodal distribution: First year of life (extravaginal), adolescents/young adults (intravaginal).
“Whirlpool” sign: Eddy swirl of coiled spermatic cord superior to testis, highly specific but less commonly seen than redundant spermatic cord.
Redundant spermatic cord AKA boggy pseudomass, torsion knot, epididymal-cord complex and should be avascular or only minimally vascular (unlike paratesticular neoplasm or acute epididymitis).
Testicles normally lie vertically, but horizontal or oblique (diagonal) lie suspicious for torsion.
Testicular enlargement, reactive hydrocele and scrotal skin thickening are secondary findings of torsion.
Marked testicular heterogeneity = Late torsion and nonviability/necrosis, more likely after 24 hours of symptoms.
Treatment: Detorsion and orchiopexy if salvageable, orchiectomy if not.

Reference: Bandarkar AN, Blask AR. Testicular torsion with preserved flow: Key sonographic features and value-added approach to diagnosis. Pediatric Radiology (2018) 48:735–744.

To learn more about the Samsung RS85 Prestige ultrasound system, please visit: https://www.bostonimaging.com/rs85-prestige-ultrasound-system-4

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