A young man presents with severe intermittent left testicular pain
Describe and interpret these scans
Image 1: Transverse view of left side of the scrotum:
As the probe sweeps inferiorly over the cord to the testis the cord is seen twisting through at least 360 degrees. Reversing the sweep back up the cord and the twist is again seen. This “whirlpool sign” is pathognomonic of testicular torsion and requires urgent intervention.
Image 2 & 3: In this case testicular flow can still be detected on colour and power Doppler.
Testicular torsion with preserved flow and sonographically evident twisted cord – the whirlpool sign
Detecting blood flow within a testis does not exclude the diagnosis of testicular torsion. Intermittent testicular torsion or torsion-detorsion may cause intermittent pain and intermittent ischaemia. Incomplete torsion is where despite some degree of torsion of the cord, blood flow has not been completely occluded.