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Imaging Acute Scrotal Pain in Adults: Torsion of the Testis and Appendages

  • Ahmet T. Turgut
  • Vikram S. Dogra
Part of the Medical Radiology book series (MEDRAD)

Abstract

Torsion of the spermatic cord is a common cause of acute scrotal pain and a delay in intervention may cause irreversible testicular damage. Intravaginal testicular torsion, which is associated either with a long mesorchium or bell-clapper deformity, accounts for most of the cases. Gray-scale US combined with color and pulsed Doppler modes is the method of choice for patients with the clinical presentation of testicular torsion, where the findings depend on the duration of torsion and the degree of twisting of the spermatic cord. The absence of testicular blood flow on color or power Doppler US is considered diagnostic of ischemia. On the other hand, the presence of color or power Doppler flow in a patient with a typical clinical presentation for torsion may be consistent with partial testicular torsion. The main role of ultrasound in the torsion of testicular appendix is to rule out testicular torsion or epididymo-orchitis. Optimization of the color and pulsed Doppler parameters is crucial for increasing the diagnostic yield.

Keywords

Spermatic Cord Inguinal Canal Testicular Torsion Diastolic Flow Testicular Infarction 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

References

  1. Adivarekar PK, Bhagwat SS, Raghavan V et al (2005) Effect of Lomodex-MgSO(4) in the prevention of reperfusion injury following unilateral testicular torsion: an experimental study in rats. Pediatr Surg Int 21:184–190PubMedCrossRefGoogle Scholar
  2. Ameur A, Zarzur J, Albouzidi A et al (2003) Testicular infarction without torsion in cryptorchism. Prog Urol 13:321–323PubMedGoogle Scholar
  3. Angell JC (1963) Torsion of the testicle. A plea for diagnosis. Lancet 1:19–21PubMedCrossRefGoogle Scholar
  4. Barada JH, Weingarten JL, Cromie WJ (1989) Testicular salvage and age-related delay in the presentation of testicular torsion. J Urol 142:746–748PubMedGoogle Scholar
  5. Baud C, Veyrac C, Couture A et al (1998) Spiral twists of the spermatic cord: a reliable sign of testicular torsion. Pediatr Radiol 28:950–954PubMedCrossRefGoogle Scholar
  6. Cassar S, Bhatt S, Paltiel HJ et al (2008) Role of spectral Doppler sonography in the evaluation of partial testicular torsion. J Ultrasound Med 27:1629–1638PubMedGoogle Scholar
  7. Dibilio D, Serafini G, Gandolofo N et al (2006) Ultrasonographic findings in isolated torsion of the epididymis. J Ultrasound Med 25:417–419PubMedGoogle Scholar
  8. Dogra V (2003) Bell-clapper deformity. Am J Roentgenol 180:1176–1177Google Scholar
  9. Dogra VS, Bhatt S (2004) Acute painful scrotum. Radiol Clin North Am 42:349–363PubMedCrossRefGoogle Scholar
  10. Dogra VS, Sessions A, Mevorach RA et al (2001) Reversal of diastolic plateau in partial testicular torsion. J Clin Ultrasound 29:105–108PubMedCrossRefGoogle Scholar
  11. Dogra VS, Bhatt S, Rubens DJ (2006) Sonographic evaluation of testicular torsion. Ultrasound Clin 1:55–66CrossRefGoogle Scholar
  12. Dogra VS, Gottlieb RH, Oka M et al (2003) Sonography of the scrotum. Radiology 227:18–36PubMedCrossRefGoogle Scholar
  13. Dogra VS, Rubens DJ, Gottlieb RH et al (2004) Torsion and beyond: new twists in spectral Doppler evaluation of the scrotum. J Ultrasound Med 23:1077–1085PubMedGoogle Scholar
  14. Donohue RE, Utley WL (1978) Torsion of spermatic cord. Urology 11:184–190CrossRefGoogle Scholar
  15. Elert A, Hegele A, Olbert P et al (2002) Isolated epididymal torsion in dissociation of testis-epididymis. Urologe A 41:364–365PubMedCrossRefGoogle Scholar
  16. Favorito LA, Cavalcante AG, Costa WS (2004) Anatomic aspects of epididymis and tunica vaginalis in patients with testicular torsion. Int Braz J Urol 30:420–424PubMedGoogle Scholar
  17. Fukuhara Y, Shiga Y, Omori Y et al (2005) Idiopathic testicular infarction: a case report. Hinyokika Kiyo 51:129–131PubMedGoogle Scholar
  18. Hörmann M, Balassy C, Philipp MO et al (2004) Imaging of the scrotum in children. Eur Radiol 14:974–983PubMedCrossRefGoogle Scholar
  19. Kadish HA, Bolfe RG (1998) A retrospective review of pediatric patients with epididymitis, testicular torsion, and torsion of testicular appendages. Pediatrics 102:73–76PubMedCrossRefGoogle Scholar
  20. Kalfa N, Veyrac C, Baud C et al (2004) Ultrasonography of the spermatic cord in children with testicular torsion: impact on the surgical strategy. J Urol 172:1692–1695PubMedCrossRefGoogle Scholar
  21. Kamaledeen S, Surana R (2003) Intermittent testicular pain: fix the testes. BJU Int 91:406–408PubMedCrossRefGoogle Scholar
  22. Kass EJ, Lundak B (1997) The acute scrotum. Pediatr Clin North Am 44:1251–1266PubMedCrossRefGoogle Scholar
  23. Lin EP, Bhatt S, Rubens DJ et al (2007) Testicular torsion: twists and turns. Semin Ultrasound CT MRI 28:317–328CrossRefGoogle Scholar
  24. Mevorach RA, Lerner RM, Greenspan BS et al (1991) Color Doppler ultrasound compared to a radionuclide scanning of spermatic cord torsion in a canine model. J Urol 145:428–433PubMedGoogle Scholar
  25. Middleton WD, Middleton MA, Dierks M et al (1997) Sonographic prediction of viability in testicular torsion: preliminary observations. J Ultrasound Med 16:23–27PubMedGoogle Scholar
  26. Noske HD, Kraus SW, Altinkilic BM et al (1998) Historical milestones regarding torsion of the scrotal organs. J Urol 159:13–16PubMedCrossRefGoogle Scholar
  27. Nussbaum-Blask AR, Rushton HG (2006) Sonographic appearance of the epididymis in pediatric testicular torsion. Am J Roentgenol 187:1627–1635CrossRefGoogle Scholar
  28. Oyen RH (2002) Scrotal ultrasound. Eur Radiol 12:19–34PubMedCrossRefGoogle Scholar
  29. Prando D (2002) Torsion of the spermatic cord: sonographic diagnosis. Ultrasound Quart 18:41–57CrossRefGoogle Scholar
  30. Prando D (2009) Torsion of the spermatic cord: the main gray-scale and Doppler sonographic signs. Abdom Imaging 34:648–661PubMedCrossRefGoogle Scholar
  31. Ravichandran A, Blades RA, Watson ME (2003) Torsion of the epididymis: a rare cause of acute scrotum. Int J Urol 10:556–557PubMedCrossRefGoogle Scholar
  32. Sanelli PC, Burke BJ, Lee L (1999) Color and spectral Doppler sonography of partial torsion of the spermatic cord. Am J Roentgenol 172:49–51Google Scholar
  33. Schulsinger D, Glassberg K, Strashun A (1991) Intermittent torsion: association with horizontal lie of the testicle. J Urol 145:1053–1055PubMedGoogle Scholar
  34. Siegel MJ (1997) The acute scrotum. Radiol Clin North Am 35:959–976PubMedGoogle Scholar
  35. Skoglund RW, McRoberts JW, Ragde H (1970) Torsion of the spermatic cord: a review of the literature and an analysis of 70 new cases. J Urol 104:604–607PubMedGoogle Scholar
  36. Turgut AT, Unsal A, Ozden E et al (2006) Unilateral idiopathic hydrocele has a substantial effect on the ipsilateral testicular geometry and resistivity indices. J Ultrasound Med 25:837–843PubMedGoogle Scholar
  37. Turgut AT, Olçücüoğlu E, Turan C et al (2007) Preoperative ultrasonographic evaluation of testicular volume and blood flow in patients with inguinal hernias. J Ultrasound Med 26:1657–1666PubMedGoogle Scholar
  38. van Dijk R, Karthaus HFM (1994) Ultrasonography of the spermatic cord in testicular torsion. Eur J Radiol 18:220–223PubMedCrossRefGoogle Scholar
  39. Vijayaraghavan SB (2006) Sonographic differential diagnosis of acute scrotum: real-time whirlpool sign, a key sign of torsion. J Ultrasound Med 25:563–574PubMedGoogle Scholar
  40. Wilbert DM, Schaerfe CW, Stern WD et al (1993) Evaluation of the acute scrotum by color-coded Doppler ultrasonography. J Urol 149:1475–1477PubMedGoogle Scholar
  41. Williamson RC (1976) Torsion of the testis and allied conditions. Br J Surg 63:465–476PubMedCrossRefGoogle Scholar
  42. Yang DM, Lim JW, Kim JE et al (2005) Torsed appendix testis: gray scale and color Doppler sonographic findings compared with normal appendix testis. J Ultrasound Med 24:87–91PubMedGoogle Scholar

Copyright information

© Springer-Verlag Berlin Heidelberg 2011

Authors and Affiliations

  1. 1.Department of RadiologyAnkara Training and Research HospitalAnkaraTurkey
  2. 2.Department of Imaging SciencesUniversity of Rochester School of MedicineRochesterUSA

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