Spontaneous testicular detorsion

Case contributed by Dr Karina Dorfman

Presentation

Left testicular pain for the last six hours.

Patient Data

Age: 15 years old
Gender: Male

Ultrasound of testes at the beginning of the examination

Ultrasound

Ultrasound of the testes demonstrates the left testis with heterogeneous echotexture without evidence of blood flow on color doppler, accompanied by mild reactive hydrocele. These findings represent left testicular torsion.

Doppler ultrasound of testes at the end of the examination

Ultrasound

At the end of the exam, a return of blood flow to the left testis was noted- initially as at a normal pattern and eventually progressing to reactive hyperemia. These findings demonstrate a real time spontaneous detorsion, that happened during the examination.

Case Discussion

Intermittent testicular torsion has been increasingly reported in the clinical literature. 
This case demonstrates the typical doppler sonography finding in testicular detorsion of increased blood flow. The increased blood flow represents reperfusion hyperemia, which may resemble the findings in orchi-epididymitis.

However, the process of detorsion is rarely demonstrated sonographically in real-time, as it is shown in this case.

The patient underwent bilateral orchiopexy without complications.

Courtesy of Dr.Maxim Pougatchev.

 

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