Presentation
3 day history of right testicular pain.
Patient Data
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.