Testicular torsion - intravaginal

Case contributed by Dr Ian Bickle

Presentation

20 year-old with 3 day history of right testicular pain.

Patient Data

Age: 20
Gender: Male
Modality: Ultrasound

Both testicles contain microlithiasis.  The symptomatic testicle has altered echogenicity of the testicular parenchyma and absence doppler flow.  This was accompanied by a small reactive hydrocele and a thickened epididymis.

During scanning it was essentially impossible to get a true longitudinal view suggesting a mal-aligned axis to the testicle.

Modality: Photo

After prompt urological review the patient went to theatre.

Intra-operative images of a torted right testicle with resultant ischaemia/infarction.

Modality: Photo

Orchidectomy sample sent for histopathological review.

Case Discussion

The appearances are in keeping with testicular torsion:

a. Altered echogenicity of the testicular parenchyma

b. Absence doppler activity in the testicular parenchyma

c. A mal-aligned testicular axis

with associated signs of:

d. Epididymal thickening

e. Hydrocele. 

Thanks to Mr Yusri Yahya, Urologist, RIPAS Hospital, Brunei for the intra-operative images.

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Case Information

rID: 21606
Case created: 3rd Feb 2013
Last edited: 7th Feb 2016
System: Urogenital
Inclusion in quiz mode: Included

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