Testicular torsion

  • Peripubertal boys, and in infancy
  • Normally tunica vaginalis converges posterior to fix testis to scrotal wall 
  • This convergence is deficient or patulous leading to ‘bell clapper’ deformity and torsion
  • Afebrile boy with acute scrotal pain and vomiting
  • Acute torsion – 24 hrs to 10 days
  • Testicular salvage rates: 80% first 6 hours, 20% if beyond 24 hrs
  • US: enlarged and heterogeneous testis and epididymis. Torted cord, scrotal wall edema, reactive hydrocele. Swollen hypo echoic testis usually can’t be salvaged. Whirlpool sign within spermatic cord has highest sensitivity 92% and specificity 99% for torsion

Testicular appendage: torsion common cause of acute scrotal pain in children. 

Read more

Ringdahl, Erika N., and Lynn Teague. “Testicular torsion.” American family physician 74.10 (2006): 1739-1743.

Baker, Linda A., et al. “An analysis of clinical outcomes using color Doppler testicular ultrasound for testicular torsion.” Pediatrics 105.3 (2000): 604-607.

Burks, Deland D., et al. “Suspected testicular torsion and ischemia: evaluation with color Doppler sonography.” Radiology 175.3 (1990): 815-821.