Ultrasound Case 007
Presentation
A young man presents with severe intermittent left testicular pain
Further views
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. | SonoCPD | Ultrasound library | Top 100 | @thesonocave |
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What strikes me odd is that during partial torsion RI index should be high whereas in this case it remains low (0,58).