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Spontaneous testicular detorsion

Case contributed by Karina Dorfman
Diagnosis almost certain

Presentation

Left testicular pain for the last six hours.

Patient Data

Age: 15 years old
Gender: Male

US of testes at the b...

ultrasound

US of testes at the beginning of the exam

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 US of testes at the...

ultrasound

Doppler US of testes at the end of the exam

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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