Clinical features
- It most commonly affects neonates and young men. Peak first 30 days of life and during (10–14 years)
- Sudden onset of fever, nausea, vomiting
- Swollen and tender affected testicle(s).
- Absent cremasteric reflex
- Negative Prehn sign
Testicular torsion is typically a clinical diagnosis. Do not delay definitive treatment for diagnostic workup if clinical suspicion is high.
Ultrasound:
is the modality of choice for evaluating the potentially torted testis in inconclusive clinical findings.
- Enlarged testis
- Twisting of spermatic cord (whirlpool sign)
- Reduced or absent blood flow to/from the affected testis
- Heterogeneous appearance of testicular parenchyma indicates testicular necrosis
- Reactive hydroceley
- Thickening of the scrotal skiny
Main US Signs
- right testis lies in an abnormal horizontal position
- intratesticular flow slightly reduced
- whirlpool sign
Color Doppler ultrasound of both testes (transverse plane) of a 14-year-old boy who woke up with acute right scrotal pain
The right testis lies in an abnormal horizontal position (white arrow), with intratesticular flow slightly reduced compared to the left testis. These findings are consistent with testicular torsion.
whirlpool sign
spiral-like pattern when the spermatic cord is assessed during ultrasonography
