Presentation
Acute left testicular pain. Had orchidopexy. US to assess for testicular viability.
Patient Data
Post orchidopexy examination
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 ...
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.