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Key Image

Sonographic images of both testicles in longitudinal plane with a color doppler overlay

Key Findings

Note the difference in appearance between the left and right testicle (use your labels in red!). The normal left testicle has a homogenous appearance with a few vessels showing flow on color doppler images (blue arrow). The abnormal right testicle has a heterogenous appearance with alternating foci of increased and decreased echoes (red arrow). No internal blood flow is identified in the right testicle.

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Diagnosis

Testicular Torsion (Subacute with Testicular Infarction)

Discussion

Recognizing acute testicular torsion in patients is important because a delay in treatment may upgrade the patient from a detorsion procedure to an orchiectomy. If the torsion is found within 4 hours, the testicle is usually salvageable. If more than 24 hours pass, the testicle will need to be removed.

- Early findings of torsion include: absent or decreased flow, enlargement, and heterogenous appearance in the affected testicle.
- Late findings include atrophy, reactive hydroceles, and peritesticular inflammation / increased flow.

The patient in this case presented 3 days after the onset of pain. The testicle was infarcted at the time of ultrasound. The alternating echogenic nodularity on ultrasound corresponds with alternating hemorrhagic and infarcted testicle found on surgical pathology.

The surgeon noted that the right testicle was torsed 720 degrees, appeared dark and necrotic. Right orchiectomy was performed. The left testicle appeared normal and left orchipexy was performed.

References / Resources

Additional Information:

1. Dahnert*: 992
2. Primer*: 241
3. Related Article:

   Dogra, VS. "Sonography of the Scrotum." Radiology April 2003: 227, 18-36.

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