Presentation
Left hemiscrotal pain and swelling.
Patient Data
The Left testis measures about (32 x 21 x 18 mm - 7.9 cc) with an ill-defined hypoechoic area along the rete testis. No focal lesion. Thickened left epididymis. No vascularity in the testis or the epididymis. No hydrocele. The short-axis cine-loops of the intrascrotal spermatic cord show twisting.
Atrophic right testis (10 x 8 x 5 mm - 0.27 cc) with diffuse hypoechoic echopattern. No testicular focal lesion/ vascularity. No hydrocele.
The first photo shows a twisted intrascrotal spermatic cord. The second photo shows an infarcted left testis and a small right hemiscrotum.
Case Discussion
A patient presented with more than seventy-two hours of left hemiscrotal pain and swelling without a history of fever or trauma. The ultrasound confirmed the clinical diagnosis of testicular torsion. Additionally, the left testis appears to be infarcted on ultrasound; which was expected due to the duration of symptoms. Grey-scale cine-loop shows a whirlpool sign of testicular torsion which is a primary or a direct sign of the torsion. Testicular findings are secondary signs.
Unfortunately, the right testis is atrophic. The patient could not recollect a previous episode of right hemiscrotal pain.
Emergency surgical exploration revealed left testicular torsion with infarction. There were three complete turns of the left spermatic cord. A left orchiectomy was done.
Surgical details and photos courtesy: operating surgeon Dr. Niraj patel and anesthesiologist Dr. Shailesh Thoria.
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