Presentation
Right hemiscrotal pain followed by swelling for the last 9 hours.
Patient Data
The left testis shows the elongated shape and smaller volume. However, it shows normal echopattern and vascularity.
The right testis is edematous with altered echopattern. There is no parenchymal flow. The right spermatic cord is edematous in the right hemiscrotum with the presence of twisting.
The intraoperative photo shows a twisted right spermatic cord. The is testis is enlarged and bluish colored. 2nd photo is after the detorsion of the cord.
Case Discussion
An adolescent presented with sudden onset of right hemiscrotal pain followed by swelling. Ultrasound shows edematous right testis with altered echopattern. There is no parenchymal flow in the right testis. The right spermatic cord shows edematous and shows a whirlpool sign. Ultrasound findings favor the right testicular torsion. The left testis is smaller in size and more elongated than normal. It shows normal parenchymal echopattern and vascularity.
Surgery was done within the next two hours. It revealed twisted right spermatic cord and secondary testicular torsion.
Orchiopexy was done for undescended left testis in early childhood. This explains smaller left testis with an elongated shape.
Intraoperative photos courtesy Dr. Niraj Patel. Dr. Shailesh Thoria.