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Musculoskeletal/Small parts » Scrotum And Testicles
Partial Testicular Torsion
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Author(s) :
Wui K. Chong, MD
 
Presentation A 20 year old male presented to the emergency room with severe left scrotal pain.
 
 
 
Caption: Transverse scan of the testicles
Description: Color Doppler demonstrates blood flow in both testes.
 
 
Caption: Color Doppler of the testicles
Description: The vessels in the left testicle demonstrate an on-off (flashing) appearance in this color Doppler video, indicating absence of flow during diastole.
 
 
 
Caption: Transverse scan of the testicles
Description: The Doppler spectral waveform obtained from the left testicle demonstrates absent diastolic flow. Spectral waveforms from the right testicle were normal appearing.
 
Differential Diagnosis Testicular torsion
Orchitis
 
Final Diagnosis Incomplete (partial) left testicular torsion.
 
Discussion Testicular torsion is a surgical emergency. Complete torsion is characterized by absence of arterial flow on Doppler examination. However, presence of color Doppler flow does not exclude torsion as in this case. Fig 1 shows apparently symmetric color flow in both testicles. When torsion is incomplete (partial) or in progress, arterial flow may still be present but with increased resistance. There will result in reduced, absent or reversed diastolic flow. The vessels in the left testicle demonstrate an on-off (flashing) appearance on the color Doppler video (Fig 2), indicating absence of flow during diastole. This is confirmed by the Doppler spectral waveform (Fig 3).
 
Case References Dogra VS, Sessions A, Mevorach RA, Rubens DJ. Reversal of diastolic plateau in partial testicular torsion. J Clin Ultrasound 2001; 29:105–108.
 
Technical Details Case performed on the Acuson Sequoia utilizing a 15MHz linear probe.
 
Follow Up The testis was found to be viable at surgery. The patient made a full recovery after orchidopexy