Intrauterine testicular torsion

Case contributed by Dr Rubens Ribeiro de Souza

Presentation

Forceps delivery. Hard and enlarged right testicle one day after birth with a darkened scrotal skin. Ultrasound was performed on the second day of life.

Patient Data

Age: 2 days old
Gender: Male
Photo

Hard and enlarged right testis at birth with a darkened scrotal skin.

Ultrasound

The right testicle is enlarged, measuring 2.8 x 2.7 x 2.1 cm, with 8,9 cm³ of volume, with a parenchyma diffusely heterogeneous showing internal hypoechoic areas of necrosis, an absence of flow on Doppler and a small septated hydrocele, compatible with testicular torsion.

The left testicle had a normal size for the age, homogeneous parenchyma, regular contours and normal visible flow on Doppler.

Case Discussion

Color Doppler Ultrasound has an excellent sensitivity for testicular torsion and should always be performed as soon as possible if this pathology is suspected. In newborns, a detailed physical examination is crucial for detecting intrauterine testicular torsions.

Extravaginal torsion of the testis is reported to be the predominant mechanism of torsion in the fetus and neonate. It happens when a twist of the spermatic cord takes place outside the sack of tunica vaginalis in the scrotum 3.

Intrauterine testicular torsion is usually seen in infants within the first 30 days of life. Five per cent of all torsions occur before or soon after birth. Of these, 72% occur prenatally and 28% postnatally 1.

A relatively short duration of torsion is characterized by mixed echogenicity. Prolonged intrauterine torsion shows calcification and a hypervascular ring of tunica with a hypodense center 2.

Considering this, the presented case seems to be a recent torsion.

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