Pediatric Testicle Torsion

  • 3 types: prenatal, extravaginal (neonatal), intravaginal (post-neonatal)
  • Prenatal
    — Etiology: Occurs in utero
    — Clinical: presents as painless palpable hard mass with pigmentation of scrotum, 75% of torsion
  • Extravaginal in neonates
    — Etiology: torsion of spermatic cord + tunica
    — Imaging: absent blood flow by color + spectral doppler US, heterogenous parenchyma, small anechoic areas, peripheral eggshell like hyperechogenicities, decreased or increased size of testicle, hydrocele, kiwi sign
    — Clinical: presents as painful red scrotum
  • Intravaginal in 3 – 20 year old
    — Etiology: torsion of spermatic cord caused by bell clapper deformity
    — Imaging: absent intratesticular blood flow by color + spectral doppler, whirlpool sign of spermatic cord, enlarged edematous testis

Radiology Cases of Testicle Torsion

US of testicular torsion
Sagittal color doppler US of the right testicle (above) shows the presence of color flow that had an arterial waveform on spectral doppler US. Sagittal color doppler US of the left testicle (below) shows the absence of color flow and no arterial waveforms could be found on spectral doppler US.