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Testicular torsion - intravaginal

Case contributed by Ian Bickle
Diagnosis certain

Presentation

3 day history of right testicular pain.

Patient Data

Age: 20 years
Gender: Male
ultrasound

Both testicles contain microlithiasis.  The symptomatic testicle has altered echogenicity of the testicular parenchyma and absence doppler flow.  This is 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.

After prompt urological review the patient went to theater.

Intra-operative images of a torsed right testicle with resultant ischemia/infarction.

Orchiectomy sample sent for histopathological review. Gross specimen (macroscopic): Marked congestion of the torsed testicle; cut surface showing marked hemorrhage within the testicle parenchyma.

Case Discussion

The appearance is in keeping with testicular torsion.

Testicular findings

  • altered echogenicity of the testicular parenchyma
  • absence Doppler activity in the testicular parenchyma
  • a malaligned testicular axis

Associated signs:

  • epididymal thickening
  • hydrocele

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

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