Patient took a soccer ball to the left scrotum. Pain was "tolerable" for several days. Pain increased on the day prior to presentation. On manual examination, there was erythema, swelling, thickening, and induration of left scrotum. Left testicle could not be separated from its epididymis.
Ultrasonic examination with Doppler interrogation demonstrated a hypoechoic left testicle with no internal flow. Head of epididymis was thickened and inhomogeneous and entire epididymis showed no internal flow. Right testicle appeared completely normal.
At surgery, left testicle was completely necrotic. Cord had torsed 540 degrees. Testicle was promptly excised and contralateral orchiopexy was performed. Of note, what had appeared at ultrasound as a thickened head of epididymis was actually part of the torsed testicular cord, or perhaps a conglomeration of both epididymal head and cord.