Reperfusion testicular hyperaemia post torsion correction

Case contributed by Dr Chris O'Donnell

Presentation

Presented with acute left testicular pain. Had orchidopexy. US to assess for testicular viability.

Patient Data

Age: 13
Gender: Male
Ultrasound

Post orchidopexy examination

Heterogeneous testicular parenchyma on the left with increased blood flow on colour Doppler (of low resistive index).  Associated scrotal swelling. This is assymetrical when compared with the right testis.

Ultrasound

Examination performed a day earlier (prior to surgery)

Heterogeneous left testis with no flow on colour Doppler as compared with the right. This is indicative of torsion.

Case Discussion

After reperfusion the testis will show hyperaemia for some time due to build up of lactate and other ischaemic factors leading to vasodilatation. This can be a trap in boys with torsion as the testis can spontaneously untort showing increased blood flow on ultrasound, thus being misinterpreted by the inexperienced operator as orchitis (obscuring the true and much more substantial torsion diagnosis).

In this case the hyperaemia has occurred post surgical repair with persistent swelling of the parenchyma causing the heterogeneity.

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Case information

rID: 35247
Case created: 29th Mar 2015
Last edited: 21st Nov 2015
System: Urogenital
Inclusion in quiz mode: Included

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