Presentation
Two days prior to the ultrasound, the patient had right-sided abdominal pain. This was followed by right-sided hemiscrotal pain and swelling.
Patient Data
The right testis is enlarged and shows a loss of normal homogeneous echopattern. The right epididymis is also enlarged with altered echopattern. The right spermatic cord shows torsion with edema proximal and distal to it. Color Doppler examination shows twisted vessels in the right spermatic cord. There is a right peri-testicular flow; however, there is no intra-testicular flow. The right hemiscotum shows a mild reactive hydrocele. Left testis reveals normal size, contour, echopattern and vascularity. Left epididymis and left spermatic cord are normal.
Right orchiectomy specimen. The testis and epididymis are edematous.
Case Discussion
An adolescent boy presented with right-sided abdominal pain followed by right-sided hemiscrotal pain and swelling. Ultrasound examination shows a twisted right spermatic cord which is a direct sign of the torsion. The indirect signs are present in the testis including an enlarged testis without parenchymal flow. There is a loss of normal echopattern of the testis which favors infarction.
Surgery undertaken within 2 hours and the right testis was not viable.
Photo courtesy: Dr. Niraj Patel, Dr. Vivek Patel.