Ultrasound Case 007

Presentation

A young man presents with severe intermittent left testicular pain

Transverse view of left side of the scrotum
Further views
Torted testis with flow
Torted testis with flow

Describe and interpret these scans

IMAGE INTERPRETATION

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.


CLINICAL CORRELATION

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.


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An Emergency physician based in Perth, Western Australia. Professionally my passion lies in integrating advanced diagnostic and procedural ultrasound into clinical assessment and management of the undifferentiated patient. Sharing hard fought knowledge with innovative educational techniques to ensure knowledge translation and dissemination is my goal. Family, wild coastlines, native forests, and tinkering in the shed fills the rest of my contented time. | SonoCPDUltrasound library | Top 100 | @thesonocave |

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