Abnormal testicular Doppler flow (differential)

Abnormal testicular Doppler flow (arterial, venous, or both) can be a differential challenge. Always remember that the patient's presenting history helps quite a bit in narrowing the differential.

Reduced flow

• partial testicular torsion (<360 degrees)
  • venous outflow is obstructed first, resulting in high resistance arterial waveforms
• testicular ischemia/infarction
  • most often a result of torsion or untreated infection
• testicular fibrosis
• extrinsic compression of the testicular and deferential arteries
  • e.g. inguinal hernia
• acute hydrocele
  • may produce subclinical alterations in intra-testicular vascular impedance ⁴
    • high-resistance spectral Doppler patterns may normalize after evacuation of the collection ³
  • may rarely cause sufficient intra-tunical pressure elevation to exert a physiology akin to compartment syndrome with resultant testicular ischemia ²
• testicular rupture

Absent flow

• complete testicular torsion (both arteries and veins are obstructed)
• extrinsic compression of the testicular and deferential arteries
  • e.g. inguinal hernia

Increased flow

• epididymo-orchitis or isolated orchitis (less common)
• testicular neoplasm
• reperfusion phase of intermittent torsion