Genitourinary Radiology > Male Pelvis > Testis > Torsion



Torsion is due to abnormal configuration of the testicle on its pedicle (“bell clapper deformity”), leading to abnormal twisting of the spermatic cord that causes testicular ischemia. It is most common in adolescents and infants less than 12 months old.

Torsion is classified as complete or incomplete.
Complete torsion: >360 degree twist. Adult males 80% testicular salvage rate when reversed within 5 hours.
Incomplete torsion: < 360 degrees. Relatively longer period before testicle is unsalvageable.

High-resolution ultrasonography with color Doppler demonstrates the following:

    Enlarged and diffusely hypoechoic testicle, or may contain multifocal hypoechoic areas
    Many have normal testicle findings
    Epididymis may be enlarged and hypoechoic
    Scrotal skin thickening
Diagnosis is made if there is no blood flow to testis (evaluated by doppler ultrasound) after 1 min of scanning time, or if there is a single small vessel in the symptomatic testis when contralateral normal testis shows readily detectable diffuse flow.

Color flow images of both testicles in a patient with left sided scrotal pain shows no flow to the testicle especially when compared with normal flow on the asymptomatic contralateral side consistent with acute left testicular torsion.

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