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Case of the Month

July 2012

Patient Data: Male patient 22 years old

Clinical Info: Acute onset of scrotal pain on the right side that started a few hours before the ultrasound examination. At the time of the examination the pain had already diminished a bit, but was still present


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Longitudinal image of the right testis with vessels seen with e-flow


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Color doppler image of the left testis


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Another color doppler image of the right testis. There are less vessels seen than on the left side


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The right testis looks completely normal


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The epididymis is slightly thickened and shows vessels with color doppler. Does this mean that there is an epididymitis?


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Transverse image of the epididymis and right testis with flow


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A part of the epididymis has a spiral aspect. Does that change your diagnosis


43630-3668849_20120209__0032.swf Videoclip of the peritesticular structures


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Color doppler image of the spiral stucture showing spiral flow


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A spiral aspect always means that there is a torsion. This is an indication for immediate surgery. Sometimes there is some flow visible in the testis and or epididymis, when the torsion is not complete. However this can very easily change.


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This is the epidydimis of a 13 year old boy with acute onset of scrotal pain on the right side. In this case there is not a spiral aspect but a knot


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This is another image of the the epidydimis of the same 13 year old boy.


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The right testis is slightly swollen


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Longitudinal image of the left normal testis for comparison


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In this case there is also minimal detectable flow in the right testis


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Is is possible to obtain a doppler signal but the velocities are extremely low


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18 year old with a painfull testis for a few hours


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There is some flow detectable


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The normal testis is not swollen and there are more vessels visible


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The doppler signal in the normal testis has a low resistance signal


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Again there is a knot visible in the transverse view indicating testicular torsion even though there is still flow detectable


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Longitudinal image with the knot dorsal of the testis

All patients were operated and the diagnosis testicular torsion was confirmed. At the time of operation the testis in these patients was already discolored. The testis was detordated and recovered quickly in all cases. In cases of an incomplete testicular torsion the symptoms can change according to the amount of torsion. Flow can be detected and does not exclude a torsion. A spiral aspect of the pertesticular vessels or a peritesticular knot is always highly suspicious for a torsion. Also look for other signs like swelling and changes in the doppler signal

For more cases of testicular torsion see

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