Testicular torsion-detorsion syndrome

Case contributed by Mohamed Saber
Diagnosis certain


Acute severe right scrotal pain 1 hour ago with swelling and marked tenderness

Patient Data

Age: 15 years
Gender: Male



Ultrasound study shows an abnormal axis and swelling of the right testis shows no color flow on duplex study denoting acute torsion. Artifacts originating from the patient's motion due to severe tenderness give pseudo color fill in.

Mild reactionary fluid is noted at the right scrotal sac

Normal vascularity of the left testicle

5 minutes later


Later on, during the same ultrasound study, the right testicle returns to the normal axis and presents hypervascularity on the color duplex study denoting spontaneous detorsion. It appears homogenous with no parenchymal changes. Hypervascular right epididymis and right scrotal sac fluid are also seen. Dramatic pain relief with no tenderness on probing is noted

Case Discussion

Partial testicular torsion with torsion-detorsion syndrome is a real clinical and imaging dilemma. In this case, it was easy to diagnose torsion-detorsion syndrome as the detorsion occurs luckily at the same ultrasound study that is an uncommon occurance. If not, the hyperemic status of the involved testis and epididymis is typically similar to epididymo-orchitis and the sonographic differentiation is really difficult to even impossible. Diastolic flow reverse and increased resistive index are described in the cases of partial testicular torsion, however, it may be seen also in severe cases of epididymo-orchitis due to marked swelling and edema compromising the venous flow indicating impending infarction.

This patient was subjected to elective bilateral orchidopexy

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