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Age: 5 days (term delivery)

Sex: Male

Indication: Scrotal swelling

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Case #8


Findings

  • Atrophic, partially calcified right testicle, located within the right hemiscrotum
  • Minimal blood flow is demonstrated in the right testicle and right epididymis
  • Mildly enlarged left testicle with no detectable flow to the left testicle or left epididymis on power Doppler analysis
  • Flow is detected to the distal aspect of the left spermatic cord
  • Large left hydrocele without internal complexity


Diagnosis

Extravaginal testicular torsion

Sample Report

Mildly enlarged left testicle with no detectable flow to the left testicle or left epididymis on power Doppler analysis. Flow is detected to the distal aspect of the left spermatic cord. These findings raise concern for left extravaginal testicular torsion. Recommend urgent surgical evaluation.

Large left hydrocele without internal complexity.

Atrophic, partially calcified right testicle with minimal blood flow to the right testicle and right epididymis, likely the result of in utero testicular torsion/infarction.


Discussion

  • Extravaginal testicular torsion is reportedly the most common form of prenatal and perinatal testicular torsion, but nonetheless is very rare
  • In contrast to intravaginal torsion where the testis spins within the tunica vaginalis, in extravaginal torsion, the testis and tunica vaginalis rotate within the scrotum, presumably due to immature/incomplete connections between the tunica vaginalis and the scrotum
  • Most commonly, extravaginal torsion occurs in utero and presents as a painless, firm testis after birth – which is likely what has happened in regard to this patient’s right testis
  • Extravaginal torsion may occur in the postnatal period, in which case the patient may present with fussiness, scrotal swelling, and pain to palpation of the involved testis
  • Unclear symptoms and the rarity of torsion in this age group may lead to delayed diagnosis and irreversible damage
  • From the perspective of ultrasound, the evaluation of intravaginal and extravaginal torsion is similar and in both situations focuses primarily on preservation of vascularity in the testis and epididymis



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