Presentation
Two-day history of left-sided testicular pain.
Patient Data
The left testicle is enlarged with heterogeneous reflectivity and no detectable color flow. The left spermatic cord is expanded. Normal appearance of the right testicle.
Subsequent ultrasound 2 months later shows the left testicle is now smaller and the parenchyma is now homogenously hypoechoic but still shows no color flow.
Case Discussion
The heterogeneous reflectivity of the left testicular parenchyma is non-specific, but the lack of color flow is in keeping with ischemia, and the swollen appearance of the cord further supports the diagnosis of torsion (subacute).
The patient was taken to the theater after the first ultrasound, where it was discovered that the left testicle had torsed 360 degrees. The subsequent follow-up ultrasound 2 months later showed appearances of chronic torsion, based on the now small and more homogenously hypoechoic left testicle.
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