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 echogenicityCOLOR 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.
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