Skip to main content
SpringerLink
Log in

Imaging Acute Scrotal Pain in Adults: Torsion of the Testis and Appendages

  • Chapter
Scrotal Pathology

Part of the book series: Medical Radiology ((Med Radiol Diagn Imaging))

  • 2433 Accesses

Abstract

Torsion of the spermatic cord is a common cause of acute scrotal pain and a delay in intervention may cause irreversible testicular damage. Intravaginal testicular torsion, which is associated either with a long mesorchium or bell-clapper deformity, accounts for most of the cases. Gray-scale US combined with color and pulsed Doppler modes is the method of choice for patients with the clinical presentation of testicular torsion, where the findings depend on the duration of torsion and the degree of twisting of the spermatic cord. The absence of testicular blood flow on color or power Doppler US is considered diagnostic of ischemia. On the other hand, the presence of color or power Doppler flow in a patient with a typical clinical presentation for torsion may be consistent with partial testicular torsion. The main role of ultrasound in the torsion of testicular appendix is to rule out testicular torsion or epididymo-orchitis. Optimization of the color and pulsed Doppler parameters is crucial for increasing the diagnostic yield.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Log in via an institution
Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 189.00
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD 249.99
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info
Hardcover Book
USD 249.99
Price excludes VAT (USA)
  • Durable hardcover edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

References

  • Adivarekar PK, Bhagwat SS, Raghavan V et al (2005) Effect of Lomodex-MgSO(4) in the prevention of reperfusion injury following unilateral testicular torsion: an experimental study in rats. Pediatr Surg Int 21:184–190

    Article  PubMed  Google Scholar 

  • Ameur A, Zarzur J, Albouzidi A et al (2003) Testicular infarction without torsion in cryptorchism. Prog Urol 13:321–323

    PubMed  Google Scholar 

  • Angell JC (1963) Torsion of the testicle. A plea for diagnosis. Lancet 1:19–21

    Article  PubMed  CAS  Google Scholar 

  • Barada JH, Weingarten JL, Cromie WJ (1989) Testicular salvage and age-related delay in the presentation of testicular torsion. J Urol 142:746–748

    PubMed  CAS  Google Scholar 

  • Baud C, Veyrac C, Couture A et al (1998) Spiral twists of the spermatic cord: a reliable sign of testicular torsion. Pediatr Radiol 28:950–954

    Article  PubMed  CAS  Google Scholar 

  • Cassar S, Bhatt S, Paltiel HJ et al (2008) Role of spectral Doppler sonography in the evaluation of partial testicular torsion. J Ultrasound Med 27:1629–1638

    PubMed  Google Scholar 

  • Dibilio D, Serafini G, Gandolofo N et al (2006) Ultrasonographic findings in isolated torsion of the epididymis. J Ultrasound Med 25:417–419

    PubMed  Google Scholar 

  • Dogra V (2003) Bell-clapper deformity. Am J Roentgenol 180:1176–1177

    Google Scholar 

  • Dogra VS, Bhatt S (2004) Acute painful scrotum. Radiol Clin North Am 42:349–363

    Article  PubMed  Google Scholar 

  • Dogra VS, Sessions A, Mevorach RA et al (2001) Reversal of diastolic plateau in partial testicular torsion. J Clin Ultrasound 29:105–108

    Article  PubMed  CAS  Google Scholar 

  • Dogra VS, Bhatt S, Rubens DJ (2006) Sonographic evaluation of testicular torsion. Ultrasound Clin 1:55–66

    Article  Google Scholar 

  • Dogra VS, Gottlieb RH, Oka M et al (2003) Sonography of the scrotum. Radiology 227:18–36

    Article  PubMed  Google Scholar 

  • Dogra VS, Rubens DJ, Gottlieb RH et al (2004) Torsion and beyond: new twists in spectral Doppler evaluation of the scrotum. J Ultrasound Med 23:1077–1085

    PubMed  Google Scholar 

  • Donohue RE, Utley WL (1978) Torsion of spermatic cord. Urology 11:184–190

    Article  Google Scholar 

  • Elert A, Hegele A, Olbert P et al (2002) Isolated epididymal torsion in dissociation of testis-epididymis. Urologe A 41:364–365

    Article  PubMed  CAS  Google Scholar 

  • Favorito LA, Cavalcante AG, Costa WS (2004) Anatomic aspects of epididymis and tunica vaginalis in patients with testicular torsion. Int Braz J Urol 30:420–424

    PubMed  Google Scholar 

  • Fukuhara Y, Shiga Y, Omori Y et al (2005) Idiopathic testicular infarction: a case report. Hinyokika Kiyo 51:129–131

    PubMed  Google Scholar 

  • Hörmann M, Balassy C, Philipp MO et al (2004) Imaging of the scrotum in children. Eur Radiol 14:974–983

    Article  PubMed  Google Scholar 

  • Kadish HA, Bolfe RG (1998) A retrospective review of pediatric patients with epididymitis, testicular torsion, and torsion of testicular appendages. Pediatrics 102:73–76

    Article  PubMed  CAS  Google Scholar 

  • Kalfa N, Veyrac C, Baud C et al (2004) Ultrasonography of the spermatic cord in children with testicular torsion: impact on the surgical strategy. J Urol 172:1692–1695

    Article  PubMed  CAS  Google Scholar 

  • Kamaledeen S, Surana R (2003) Intermittent testicular pain: fix the testes. BJU Int 91:406–408

    Article  PubMed  CAS  Google Scholar 

  • Kass EJ, Lundak B (1997) The acute scrotum. Pediatr Clin North Am 44:1251–1266

    Article  PubMed  CAS  Google Scholar 

  • Lin EP, Bhatt S, Rubens DJ et al (2007) Testicular torsion: twists and turns. Semin Ultrasound CT MRI 28:317–328

    Article  CAS  Google Scholar 

  • Mevorach RA, Lerner RM, Greenspan BS et al (1991) Color Doppler ultrasound compared to a radionuclide scanning of spermatic cord torsion in a canine model. J Urol 145:428–433

    PubMed  CAS  Google Scholar 

  • Middleton WD, Middleton MA, Dierks M et al (1997) Sonographic prediction of viability in testicular torsion: preliminary observations. J Ultrasound Med 16:23–27

    PubMed  CAS  Google Scholar 

  • Noske HD, Kraus SW, Altinkilic BM et al (1998) Historical milestones regarding torsion of the scrotal organs. J Urol 159:13–16

    Article  PubMed  CAS  Google Scholar 

  • Nussbaum-Blask AR, Rushton HG (2006) Sonographic appearance of the epididymis in pediatric testicular torsion. Am J Roentgenol 187:1627–1635

    Article  Google Scholar 

  • Oyen RH (2002) Scrotal ultrasound. Eur Radiol 12:19–34

    Article  PubMed  Google Scholar 

  • Prando D (2002) Torsion of the spermatic cord: sonographic diagnosis. Ultrasound Quart 18:41–57

    Article  Google Scholar 

  • Prando D (2009) Torsion of the spermatic cord: the main gray-scale and Doppler sonographic signs. Abdom Imaging 34:648–661

    Article  PubMed  Google Scholar 

  • Ravichandran A, Blades RA, Watson ME (2003) Torsion of the epididymis: a rare cause of acute scrotum. Int J Urol 10:556–557

    Article  PubMed  CAS  Google Scholar 

  • Sanelli PC, Burke BJ, Lee L (1999) Color and spectral Doppler sonography of partial torsion of the spermatic cord. Am J Roentgenol 172:49–51

    CAS  Google Scholar 

  • Schulsinger D, Glassberg K, Strashun A (1991) Intermittent torsion: association with horizontal lie of the testicle. J Urol 145:1053–1055

    PubMed  CAS  Google Scholar 

  • Siegel MJ (1997) The acute scrotum. Radiol Clin North Am 35:959–976

    PubMed  CAS  Google Scholar 

  • Skoglund RW, McRoberts JW, Ragde H (1970) Torsion of the spermatic cord: a review of the literature and an analysis of 70 new cases. J Urol 104:604–607

    PubMed  CAS  Google Scholar 

  • Turgut AT, Unsal A, Ozden E et al (2006) Unilateral idiopathic hydrocele has a substantial effect on the ipsilateral testicular geometry and resistivity indices. J Ultrasound Med 25:837–843

    PubMed  Google Scholar 

  • Turgut AT, OlçücüoÄŸlu E, Turan C et al (2007) Preoperative ultrasonographic evaluation of testicular volume and blood flow in patients with inguinal hernias. J Ultrasound Med 26:1657–1666

    PubMed  Google Scholar 

  • van Dijk R, Karthaus HFM (1994) Ultrasonography of the spermatic cord in testicular torsion. Eur J Radiol 18:220–223

    Article  PubMed  Google Scholar 

  • Vijayaraghavan SB (2006) Sonographic differential diagnosis of acute scrotum: real-time whirlpool sign, a key sign of torsion. J Ultrasound Med 25:563–574

    PubMed  Google Scholar 

  • Wilbert DM, Schaerfe CW, Stern WD et al (1993) Evaluation of the acute scrotum by color-coded Doppler ultrasonography. J Urol 149:1475–1477

    PubMed  CAS  Google Scholar 

  • Williamson RC (1976) Torsion of the testis and allied conditions. Br J Surg 63:465–476

    Article  PubMed  CAS  Google Scholar 

  • Yang DM, Lim JW, Kim JE et al (2005) Torsed appendix testis: gray scale and color Doppler sonographic findings compared with normal appendix testis. J Ultrasound Med 24:87–91

    PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Radiology, Ankara Training and Research Hospital, 06590, Ankara, Turkey

    Ahmet T. Turgut

  2. Department of Imaging Sciences, University of Rochester School of Medicine, 601 Elmwood Ave, Box 648, Rochester, NY, 14642, USA

    Vikram S. Dogra

Authors
  1. Ahmet T. Turgut
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Vikram S. Dogra
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Ahmet T. Turgut .

Editor information

Editors and Affiliations

  1. Ospedale di Cattinara, Ist. Radiologia, Università Trieste, Strada di Fiume 149, Trieste, 34149, Italy

    Michele Bertolotto

  2. Ospedale di Cattinara, Department of Urology, University of Trieste, Strada di Fiume 447, Trieste, 34149, Italy

    Carlo Trombetta

Rights and permissions

Reprints and permissions

Copyright information

© 2011 Springer-Verlag Berlin Heidelberg

About this chapter

Cite this chapter

Turgut, A.T., Dogra, V.S. (2011). Imaging Acute Scrotal Pain in Adults: Torsion of the Testis and Appendages. In: Bertolotto, M., Trombetta, C. (eds) Scrotal Pathology. Medical Radiology(). Springer, Berlin, Heidelberg. https://doi.org/10.1007/174_2011_178

Download citation

  • DOI: https://doi.org/10.1007/174_2011_178

  • Publisher Name: Springer, Berlin, Heidelberg

  • Print ISBN: 978-3-642-12455-6

  • Online ISBN: 978-3-642-12456-3

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics

Search

Navigation