Reperfusion testicular hyperemia post torsion correction

Case contributed by Chris O'Donnell
Diagnosis certain

Presentation

Acute left testicular pain. Had orchidopexy. US to assess for testicular viability.

Patient Data

Age: 15 years
Gender: Male

Post orchidopexy examination

ultrasound

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

exam performed a day ...

ultrasound

exam performed a day earlier prior to surgery

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

Case Discussion

After reperfusion the testis will show hyperemia for some time due to build up of lactate and other ischemic 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 hyperemia has occurred post surgical repair with persistent swelling of the parenchyma causing the heterogeneity.

How to use cases

You can use Radiopaedia cases in a variety of ways to help you learn and teach.

Creating your own cases is easy.

Updating… Please wait.

 Unable to process the form. Check for errors and try again.

 Thank you for updating your details.