- 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.