Neonatal testicular torsion

Case contributed by Dr Ibrahim M. Jubarah

Presentation

On post-natal clinical examination by a pediatrician, the patient was not irritable but had a right-sided scrotal hard swelling, suspecting a testicular mass. Scrotal ultrasound was requested.

Patient Data

Age: one day
Gender: Male

Scrotum

Ultrasound

The right testicle appears swollen, heterogeneous echogenicity, and a hypoechoic linear radiating foci, with no detected Doppler color flow.

The left testicle shows a normal size and echogenicity.

Photo

A right testicular excision surgery was done, revealing a mostly black colored testicle denoting non-viable right testicle.

Case Discussion

In testicular torsion suspected cases, the calmness status of the patient on examination (clinical and sonographic) should raise the possibility of irreversible changes that crossed over the more potentially painful acute phase, keeping in mind detorsion probability.

Often, the Doppler color flow and pulsed wave are difficult to be detected in children's normal testicular ultrasound, limiting the diagnosis-dependent features on echopattern and size change with clinical correlation. 

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