Intermittent testicular torsion in the pediatric patient: sonographic indicators of a difficult diagnosis

Martha M Munden, Jennifer L Williams, Wei Zhang, James E Crowe, Reginald F Munden, Lars J Cisek
AJR. American Journal of Roentgenology 2013, 201 (4): 912-8

OBJECTIVE: The purpose of this study was to determine whether intermittent testicular torsion, defined as the sudden onset of unilateral scrotal pain of short duration with spontaneous resolution, has sonographic indicators that can be used to establish the diagnosis.

MATERIALS AND METHODS: A retrospective search for pediatric patients presenting with suspected intermittent testicular torsion over a 2-year period was performed. The sonographic findings, medical records for clinical presentation, surgical outcomes, and comorbidities relevant to intermittent testicular torsion were reviewed.

RESULTS: Analysis was performed on two separate categories for intermittent testicular torsion: total patient episodes (n = 19) and surgical cases (n = 10), with a total of 15 patients with 1.26 episodes per patient. Of the 19 episodes of intermittent testicular torsion, 63% (12) had either absent flow followed by normal to increased flow (n = 6, p = 0.18) or increased testicular flow (n = 6), 26% (5) had normal flow, and 10.5% (2) had decreased flow. Of the total episodes of intermittent testicular torsion, 79% (15) had a whirlpool sign or pseudomass, 10.5% (2) had neither a whirlpool sign or pseudomass but a "boggy" thickened cord, and 10.5% (2) had a normal appearance of the spermatic cord with no pseudomass.

CONCLUSION: The whirlpool sign or an abnormal boggy cord and pseudomass formation below the twisted spermatic cord were both significant findings to support a diagnosis of intermittent testicular torsion. Although change from no perfusion to perfusion during the examination was not statistically significant in our cases, when present it led to the correct diagnosis in each case.

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