Testicular torsion is a twisting of the spermatic
cord. This twisting results in the loss of blood supply to the
testis and blocks the venous drainage of blood from the testicle.
Testicular torsion usually presents with acute pain and swelling
but may present as a painless scrotal swelling particularly in
young children. Surgery must be performed because the occlusion
of the blood supply to the testis must be restored within 6 hours
to prevent necrosis or infarction of the testis. Patients with
testicular torsion have sudden severe testicular pain, nausea
and vomiting. The left testicle is more often affected than is
In the early stages the testis appears normal.
In the acute phase, the epididymis and testis enlarge and the
testis appears hypoechoic (9) and inhomogeneous (5). Colour Doppler
ultrasound may show decreased or absent blood flow to the testis
(2, 3, 4). The testis may also appear rather high in the scrotum
and may be noted to have a rather horizontal axis.. After 24 hours,
the hypoechoic testicle becomes enlarged and a hydrocoele may
develop (7). The testis then atrophies making the epididymus appear
relatively large and echogenic in comparison.
* The main differential diagnosis of testicular torsion in clinical
practice is that of epididymo-orchitis.
* Ischaemic orchitis occurs as result of testicular infarction
following a testicular torsion or scrotal surgery where extensive
dissection of the spermarie cord to mobilise the testis is carried
* Testicular trauma or disruption.
* Intrascrotal haematoma
* Scrotal hernia (incarcerated) (1).
* Granuloma - tuberculoses, sarcoid.
Is surgery. The timing of the diagnosis is critical to the prognosis.
If surgery occurs within 6 hours of the onset of symptoms, 80%
to 100% of torsed testicles are saved. Surgery occurring between
6 and 12 hours of the onset of symptoms almost always results
in the loss of the testicle (8).
* 1: Derksen RJ, van der Vlist GJ, van Dalen T. [The 'acute scrotum'
in children: the clinical presentation as indicated by a rapid
operation] Ned Tijdschr Geneeskd. 2005 Jan 15;149(3):113-5.
* 2: Kalfa N, Veyrac C, Baud C, Couture A, Averous M, Galifer
RB. Ultrasonography of the spermatic cord in children with testicular
torsion: impact on the surgical strategy. J Urol. 2004 Oct;172(4
Pt 2):1692-5; discussion 1695.
* 3: Dogra VS, Rubens DJ, Gottlieb RH, Bhatt S. Torsion and beyond:
new twists in spectral Doppler evaluation of the scrotum. J Ultrasound
Med. 2004 Aug;23(8):1077-85. Review.
* 4: Prando D. Torsion of the spermatic cord: sonographic diagnosis.
Ultrasound Q. 2002 Mar;18(1):41-57.
* 5. Washowich TL: Synchronous bilateral testicular torsion in
an adult, / Ultrasound Med 20:933-935, 2001.
* 6. Gill KA: Abdominal ultrasound, Philadelphia, 2001, WB Saunders.
* 8. Kawamura DM: Abdomen and superficial structures, ed 2, Philadelphia
and New York, 1997, Lippincott.
* 9. Krebs ÇA, Giyanani VL, Eisenberg RL: Ultrasound atlas of
diseuse processes, Norwalk, Conn, 1993, Appleton & Lange.
* 10: Karmazyn B, Steinberg R, Kornreich L, Freud E, Grozovski
S, Schwarz M, Ziv N, Livne P. Clinical and sonographic criteria
of acute scrotum in children: a retrospective study of 172 boys.
Pediatr Radiol. 2004 Oct 16.