Testicular torsion

Case contributed by Dr Maulik S Patel

Presentation

Left hemiscrotal pain and swelling for the last 3 days.

Patient Data

Age: 20 months
Gender: Male
Ultrasound

The left testis and left epididymis are edematous. The intra-testicular vascular flow could not be demonstrated. There is edema of the intrascrotal left spermatic cord and left hemiscrotal wall.

The right testis is normal in size and echopattern. The right spermatic cord shows normal echotexture and thickness.

Photo

Intraoperative photos show a twisted left spermatic cord and edematous non viable left testis.

Case Discussion

A child presented with a history of left hemiscrotal pain, swelling for the last 3 days. Ultrasound shows edematous left testis without flow signal which are secondary signs of the torsion. The left spermatic cord is thick and hypoechoic. However, twisting of cord; which is a primary sign of torsion could not be demonstrated on the ultrasound. Due to excessive crying by the child, doppler evaluation was suboptimal.

The surgery was done within a few hours. Intraoperative photos show a twisted cord (a primary sign of the torsion ) and edematous testis (a secondary sign of torsion). Unfortunately, the torsed testis was not viable.

Intraoperative photos courtesy Dr. Samir Vadher, Dr. Shailesh Thoria.

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