Presentation
Enlarged right testicle on postnatal checkup.
Patient Data
Right testis swollen, with heterogeneously hypoechoic echotexture. Normal-appearing arterial and venous flow demonstrated. Entire right epididymis thickened, tiny hypoechoic focus at its head - most probably epididymal cyst. Large right hydrocele with septa. Dissection of fluid between the right hemiscrotal skin and tunicas.
Black, necrotic right testis exposed. Thrombotic epididymis.
Case Discussion
Uneventful vaginal birth. Swollen right hemiscrotum seen and palpated on first postnatal checkup. Due to discoloration, an ultrasound examination was performed. The clinical picture was of intrauterine testicular torsion, despite normal arterial and venous waveforms demonstrated on Doppler interrogation.
Later that same day, the baby was operated on. The right testis, epididymis, and distal cord were thrombotic and necrotic. The testis was removed.
The important take home message here is that in cases of infantile-pediatric testicular torsion, the clinical signs are of utmost importance and evidently, even normal Doppler waveforms can be seen in a necrotic testis. A self-assured urologist will oftentimes not request an ultrasound examination for verification of testicular torsion before performing detorsion and orchidopexy. Of course, in this specific case, the testis could not be salvaged, as it had torsed while still in utero.
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