Torsion of the testis and spermatic cord

Case contributed by Dr Silvia Moguillansky

Presentation

Swelling and pain of left scrotum for 2 days

Patient Data

Age: 12 years
Gender: Male
Ultrasound

Ultrasound

Testicular blood flow is visualized on the normal side but is absent on the affected side (left) and we see in the spermatic cord the whirpool sign. The diagnostic of testicular torsion was confirmed with surgery.

Case Discussion

Testicular torsion, with torsion of the spermatic cord, is a relatively common due to obstruction of the arterial blood supply to the testis. A fast diagnosis is important to save the testicle. However, atypical presentations of testicular torsion may delay recognition of the condition. We must also differentiate between this and other causes of acute scrotum which can delay the diagnosis produced  testicular necrosis. Diagnostic imaging, particularly Doppler ultrasonography, plays an important role in the assessment of the patient with acute scrotal pain.

The differential diagnosis includes

The ability to rapidly distinguish between these possibilities is important because the morbidity of testicular ischemia is high and there is a need to institute appropriate treatment

Testicular torsion, or twisting of the spermatic cord, usually causes first venous and then later arterial flow obstruction. The amount of testicular necrosis depends of the duration of the torsion and the degree of torsion. Torsion of greater than 6 hours usually results in a nonviable testicle.

Whirpool sign is highly reliable for the direct confirmation of diagnosis of testicular torsion, especially with the presence of vascular flow in the testis with torsion and detorsion twisting

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Case information

rID: 40836
Case created: 4th Nov 2015
Last edited: 9th Nov 2015
Inclusion in quiz mode: Excluded

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