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Age: 16

Sex: Male

Indication: Right testicle pain

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Case #19


Findings

  • Free-floating appearance of the right testicle, which appears unattached to the tunica vaginalis
  • Moderate right hydrocele with internal echogenic material
  • Normal size, echogenicity, and vascularity of the bilateral testes and epididymides
  • Small, simple appearing left hydrocele


Diagnosis

Bell clapper deformity

Sample Report

No evidence of testicular torsion. However, there is an apparent bell clapper deformity of the right testicle, which places the patient at increased risk for torsion. Recommend urology evaluation.

Moderate-sized, mildly complex left hydrocele.


Discussion

  • Unfortunately, testicular torsion is not always a straightforward diagnosis. In particular, cases of torsion-detorsion or torsion with preserved flow present a diagnostic challenge and can be easily missed
  • It is important to look for additional signs including swirling of vessels in the spermatic cord (“whirlpool sign”), redundant, twisted appearance of the spermatic cord, and evidence of a bell clapper deformity
  • The primary risk factor for testicular torsion is the bell clapper deformity, where the tunica vaginalis has a high attachment on the spermatic cord, leaving the testicle unanchored to the scrotal wall and allowing for free rotation
  • Some signs of a bell clapper deformity include a free floating appearance of the testis in the intravaginal space and asymmetric rotation of the involved testis with a more horizontal lie



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