હદય ના સ્નાયુને પણ બીજા સ્નાયુ

હદય ના સ્નાયુને પણ બીજા સ્નાયુ 

Color Doppler Findings of Testicular Torsion

TESTICULAR TORSION

    Testicular torsion is a result of excessive mobility of testis. Most torsion is seen at puberty (intravaginal) with a peak during neonatal period ( extravaginal at the cord) and is usually bilateral requiring bilateral orchiopexy.

     Ultrasonography finding vary depending on the time elapsed between the onset of episode and the examination.

 Acute Phase ( within 6 hours)

 *  Normal findings

 *  Scrotal wall thickening

 * Enlarged hypoechoic testis and epididymis.

Early subacute phase (1-4 days)

 * Acute finding are more obvious

 *  Echofree area of liquefactive necrosis

 * Hypoechoic mass of hemorrhage.

Late subacute phase (5-10 days)

 *  Progressive decrease of early subacute phase findings

Chronic phase ( over 10 days)

*  Normalisation of findings

*  Testis small and echopoor

* Persistent epididymal enlargement and increased echogenicity
COLOR DOPPLER FINDINGS OF TESTIS

Acute phase (figs. 14.4)

  * Diminished or absent flow to the testis.

  * Normal peritesticular flow.

                        Figure 14.4: Torsion of testis - complete absence of color flow in the testis 

                                          ( lowest velocty setting used for Doppler study)

Late phase (3-8 Day) (figs.14.5 and 14.6)

  * Persistence of decreased flow to testis

  * Increased peritesticular flow.

            Figure 14.5: Late phase of testicilar- No flow seen in the testis. Peritesticular flow is present

Figure. 14.6 : Power Doppler highlights exuberant peritessticular flow and absence of flow in the                              testis

  Although much has been written about the usefulness of color Doppler to detect torsion of testis, recent studies indicate that surgery need not be delayed by an altrasound study if high degree of clinical suspicion persists. Color Doppler imaging is rendered less useful in following conditions:

1. Prepubertal testis which normally have low flow.

2. Ectopic testis.

3. Torsion detorsion state previously torsed testis is now reperfused

    and color flow may be normal or hypervascular.

4. Sevare epididymo-orchitis causing secondary ischemia.

   The recently reported most reliable sign is a  snail shell curl of the epididymis and not the color flow abnormalities.