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Testicular torsion

Diagnosis certain

Presentation

Right testicular pain almost 3 days ago

Patient Data

Age: 15 years
Gender: Male
ultrasound

Left testicular ultrasound images are normal, whereas the right testis and epididymis present with increased size, heterogeneous echotexture and reactive thickening of the scrotal skin. On color Doppler examination there is an absence of blood flow in the right testis and epididymides, besides peripheral testicular neovascularization.

Case Discussion

Testicular torsion is a surgical emergency and for testicular salvage, time is crucial. Usually, the pain is acute and extremely severe, which, curiously, was not the case for the patient presented above. Actually, he only requested medical assistance because he noticed right scrotal swelling and erythema developing on the third day.

Doppler ultrasonography provides rapid assessment of the vascularity of the testis. It is both highly specific and sensitive in diagnosing torsion as well as other pathologies that can cause an acute scrotum. The findings consistent with testicular torsion include reduced or absent Doppler color or waveforms and parenchymal heterogeneity compared with the contralateral testis.

Contributed by Dr Guilherme Pioli Resende MD and Dr Marcello Antônio de Rezende Basilio MD.

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