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Year : 2018  |  Volume : 13  |  Issue : 4  |  Page : 215-216

Testicular torsion causing infarction of testis, ultrasonography and color Doppler imaging

Department of Radiology, Jawaharlal Nehru Medical College, Wardha, Maharashtra, India

Date of Web Publication16-Apr-2019

Correspondence Address:
Dr. Kartheek Goje
Department of Radiology, Jawaharlal Nehru Medical College, Sawangi (Meghe), Wardha, Maharashtra
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/jdmimsu.jdmimsu_60_18

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We report a case of testicular infarction in an 18-year-old male who presented with left testicular pain and swelling for 2 weeks duration. He presented late in our hospital. This case is reported for demonstrating the complication of testicular torsion and to stress the importance of early diagnosis in case of testicular torsion.

Keywords: Color Doppler, infarction, testicular infarction, testicular torsion, ultrasound

How to cite this article:
Goje K, Phatak SV. Testicular torsion causing infarction of testis, ultrasonography and color Doppler imaging. J Datta Meghe Inst Med Sci Univ 2018;13:215-6

How to cite this URL:
Goje K, Phatak SV. Testicular torsion causing infarction of testis, ultrasonography and color Doppler imaging. J Datta Meghe Inst Med Sci Univ [serial online] 2018 [cited 2020 May 25];13:215-6. Available from: http://www.journaldmims.com/text.asp?2018/13/4/215/256214

  Introduction Top

In prepubertal and adolescent age boys, testicular torsion is the most common cause of acute pain in scrotum. In all young males with a history of scrotal swelling and pain, intermittent testicular torsion should be ruled out.[1] In a case of testicular torsion, the probability of ischemic changes increases with increase in duration. Major cause of delayed diagnosis which commonly leads to orchidectomy is the late presentation of a patient to the hospital.[2] Acute scrotal swelling in children indicates torsion of the testis until proven otherwise. In majority of patients, history and physical examination can make an accurate diagnosis.[3]

  Case Report Top

An 18-year-old male presented to our hospital with left testicular pain and swelling for 2 weeks duration. The patient did not consult any medical practitioner about his complaints and presented in our hospital nearly after 2 weeks of onset of testicular pain. The pain was sudden in onset, it was a continuous stretching type of pain which aggravated on walking, and it was associated with three episodes of vomiting. Pain was followed by swellings which were initially small (1 cm × 1 cm) but gradually kept on increasing in size. On examination, the left testis was enlarged nontender which was hard in consistency, and the right testis appeared normal. Ultrasound examination of the scrotum revealed enlarged left testis (4.5 cm × 3.2 cm) showing heterogenous echogenicity with necrotic areas within [Figure 1]. No flow could be identified on color Doppler in the left testis [Figure 2]. Epididymis on the upper pole of left testis was seen showing the characteristic torsion knot or whirlpool pattern in the form of a twisted hyperechoic mass measuring 3.1 cm × 2.1 cm [Figure 3]. The right testis appears normal in size, shape and echotexture [Figure 4]. The patient was operated for left-sided orchidectomy and left-sided intravaginal testicular torsion was confirmed at surgery.
Figure 1: Enlarged hypoechoic left testis (4.4 cm × 3.2 cm) resulting from torsion causing necrosis and scrotal skin thickening of left hemiscrotum

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Figure 2: Color Doppler of the left testis showing absent flow within the testis

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Figure 3: Hyperechoic twisted epididymis (3.1 cm × 2.1 cm) showing the characteristic torsion knot or whirlpool pattern

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Figure 4: Right testis on color Doppler showing normal flow

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  Discussion Top

Testicular torsion is a surgical emergency; the viability of testis is directly related to the duration of ischemia.[4] Torsion can happen at any age; it is most common in adolescent boys.[4] “Bell-clapper” is a predisposing variant of scrotal anatomy where the tunica vaginalis encircles the testis, distal spermatic cord, and scrotum completely rather than attaching to the posterolateral side of the testis.[5] The bell-clapper deformity is present in 12% of men and boys and is bilateral in 80% of cases.[6]

Testicular torsion in its early phase can show normal echogenicity on ultrasound, but with progression of time, it can show enlargement and heterogeneous to hyperechoic picture on ultrasound. Increase in size with heterogeneous echotexture and hypervascularity of scrotal wall are indicative of necrosis and infarction of testis.[7]

Color Doppler is the most commonly used imaging modality to differentiate between nonsurgical and surgical cases of pediatric population with acute scrotal pain. A complete testicular torsion can be diagnosed when color Doppler shows absence of flow on the affected side and normal flow in the normal testis. The epididymis appearing hyperechoic and enlarged is a helpful sign in diagnosing prepubertal testicular torsion or a case of testicular torsion showing deceased flow on color Doppler.[8]

Declaration of patient consent

The authors certify that they have obtained all appropriate patient consent forms. In the form the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.

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Conflicts of interest

There are no conflicts of interest.

  References Top

Al-Salem AH. Intra-uterine testicular torsion: Early diagnosis and treatment. BJU Int 1999;83:1023-5.  Back to cited text no. 1
Kuremu RT. Testicular torsion: Case report. East Afr Med J 2004;81:274-6.  Back to cited text no. 2
Minevich E, McQuiston LT, Talavera F, Wolf JS Jr., Rackley R, Raz S, et al. Testicular torsion. J Urol 2007;177:297-301.  Back to cited text no. 3
Dogra VS, Gottlieb RH, Oka M, Rubens DJ. Sonography of the scrotum. Radiology 2003;227:18-36.  Back to cited text no. 4
Dogra V. Bell-clapper deformity. AJR Am J Roentgenol 2003;180:1176.  Back to cited text no. 5
Caesar RE, Kaplan GW. Incidence of the bell-clapper deformity in an autopsy series. Urology 1994;44:114-6.  Back to cited text no. 6
Baud C, Veyrac C, Couture A, Ferran JL. Spiral twist of the spermatic cord: A reliable sign of testicular torsion. Pediatr Radiol 1998;28:950-4.  Back to cited text no. 7
Nussbaum Blask AR, Rushton HG. Sonographic appearance of the epididymis in pediatric testicular torsion. AJR Am J Roentgenol 2006;187:1627-35.  Back to cited text no. 8


  [Figure 1], [Figure 2], [Figure 3], [Figure 4]


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