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Ultrasound
Diagnosis
Scrotum
CEUS Scrotum: Testicular Torsion
CEUS Scrotum: Testicular Torsion
Vasileios Rafailidis, MD, MSc, PhD, EDiR; Gibran Timothy Yusuf, BSc (Hons), MBBS, FRCR; Paul S. Sidhu, BSc, MBBS, MRCP, FRCR, DTM&H
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KEY FACTS

  • Terminology

    • Imaging

      TERMINOLOGY

      • Synonyms

        • Testicular torsion or spermatic cord torsion

      • Definitions

        • Term testicular torsion refers to twisting of spermatic cord, which results in infarction of testicular parenchyma due to cessation of blood supply
          • Apart from spermatic cord torsion, testicular infarction can also result from severe epididymoorchitis, trauma, hematological disorders, such as polycythemia and sickle cell disease, vasculitides, and previous surgery
        • Torsion of epididymal or testicular appendage refers to torsion of small structure attached to epididymis or testis, representing developmental remnants

      PATHOLOGY

      • General Features

        CLINICAL IMPLICATIONS

        • Presentation

          • Treatment

            IMAGING

            • General Features

              • Technical Recommendations

                • US Findings

                  • CEUS Findings

                    DIFFERENTIAL DIAGNOSIS

                    • Testicular Ischemia

                      Selected References

                      1. Bandarkar AN et al: Testicular torsion with preserved flow: key sonographic features and value-added approach to diagnosis. Pediatr Radiol. 48(5):735-744, 2018
                      2. Sidhu PS et al: The EFSUMB guidelines and recommendations for the clinical practice of contrast-enhanced ultrasound (CEUS) in non-hepatic applications: Update 2017 (Long Version). Ultraschall Med. 39(2):e2-e44, 2018
                      3. Tsili AC et al: MRI of the scrotum: Recommendations of the ESUR Scrotal and Penile Imaging Working Group. Eur Radiol. 28(1):31-43, 2018
                      4. Badea R et al: Contrast enhanced harmonic ultrasonography for the evaluation of acute scrotal pathology. A pictorial essay. Med Ultrason. 18(1):110-5, 2016
                      5. Rafailidis V et al: Sonography of the scrotum: from appendages to scrotolithiasis. J Ultrasound Med. 34(3):507-18, 2015
                      6. Tsili AC et al: MR imaging of scrotum. Magn Reson Imaging Clin N Am. 22(2):217-38, vi, 2014
                      7. Yusuf GT et al: A review of ultrasound imaging in scrotal emergencies. J Ultrasound. 16(4):171-8, 2013
                      8. Yusuf G et al: Global testicular infarction in the presence of epididymitis: clinical features, appearances on grayscale, color Doppler, and contrast-enhanced sonography, and histologic correlation. J Ultrasound Med. 32(1):175-80, 2013
                      9. Bertolotto M et al: Acute segmental testicular infarction at contrast-enhanced ultrasound: early features and changes during follow-up. AJR Am J Roentgenol. 196(4):834-41, 2011
                      10. Valentino M et al: Role of contrast enhanced ultrasound in acute scrotal diseases. Eur Radiol. 21(9):1831-40, 2011
                      11. Nussbaum Blask AR et al: Sonographic appearance of the epididymis in pediatric testicular torsion. AJR Am J Roentgenol. 187(6):1627-35, 2006
                      12. Paltiel HJ et al: Pulse-inversion US imaging of testicular ischemia: quantitative and qualitative analyses in a rabbit model. Radiology. 239(3):718-29, 2006
                      13. Vijayaraghavan SB: Sonographic differential diagnosis of acute scrotum: real-time whirlpool sign, a key sign of torsion. J Ultrasound Med. 25(5):563-74, 2006
                      14. Wilbert DM et al: Evaluation of the acute scrotum by color-coded Doppler ultrasonography. J Urol. 149(6):1475-7, 1993
                      Related Anatomy
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                      Related Differential Diagnoses
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                      References
                      Tables

                      Tables

                      KEY FACTS

                      • Terminology

                        • Imaging

                          TERMINOLOGY

                          • Synonyms

                            • Testicular torsion or spermatic cord torsion

                          • Definitions

                            • Term testicular torsion refers to twisting of spermatic cord, which results in infarction of testicular parenchyma due to cessation of blood supply
                              • Apart from spermatic cord torsion, testicular infarction can also result from severe epididymoorchitis, trauma, hematological disorders, such as polycythemia and sickle cell disease, vasculitides, and previous surgery
                            • Torsion of epididymal or testicular appendage refers to torsion of small structure attached to epididymis or testis, representing developmental remnants

                          PATHOLOGY

                          • General Features

                            CLINICAL IMPLICATIONS

                            • Presentation

                              • Treatment

                                IMAGING

                                • General Features

                                  • Technical Recommendations

                                    • US Findings

                                      • CEUS Findings

                                        DIFFERENTIAL DIAGNOSIS

                                        • Testicular Ischemia

                                          Selected References

                                          1. Bandarkar AN et al: Testicular torsion with preserved flow: key sonographic features and value-added approach to diagnosis. Pediatr Radiol. 48(5):735-744, 2018
                                          2. Sidhu PS et al: The EFSUMB guidelines and recommendations for the clinical practice of contrast-enhanced ultrasound (CEUS) in non-hepatic applications: Update 2017 (Long Version). Ultraschall Med. 39(2):e2-e44, 2018
                                          3. Tsili AC et al: MRI of the scrotum: Recommendations of the ESUR Scrotal and Penile Imaging Working Group. Eur Radiol. 28(1):31-43, 2018
                                          4. Badea R et al: Contrast enhanced harmonic ultrasonography for the evaluation of acute scrotal pathology. A pictorial essay. Med Ultrason. 18(1):110-5, 2016
                                          5. Rafailidis V et al: Sonography of the scrotum: from appendages to scrotolithiasis. J Ultrasound Med. 34(3):507-18, 2015
                                          6. Tsili AC et al: MR imaging of scrotum. Magn Reson Imaging Clin N Am. 22(2):217-38, vi, 2014
                                          7. Yusuf GT et al: A review of ultrasound imaging in scrotal emergencies. J Ultrasound. 16(4):171-8, 2013
                                          8. Yusuf G et al: Global testicular infarction in the presence of epididymitis: clinical features, appearances on grayscale, color Doppler, and contrast-enhanced sonography, and histologic correlation. J Ultrasound Med. 32(1):175-80, 2013
                                          9. Bertolotto M et al: Acute segmental testicular infarction at contrast-enhanced ultrasound: early features and changes during follow-up. AJR Am J Roentgenol. 196(4):834-41, 2011
                                          10. Valentino M et al: Role of contrast enhanced ultrasound in acute scrotal diseases. Eur Radiol. 21(9):1831-40, 2011
                                          11. Nussbaum Blask AR et al: Sonographic appearance of the epididymis in pediatric testicular torsion. AJR Am J Roentgenol. 187(6):1627-35, 2006
                                          12. Paltiel HJ et al: Pulse-inversion US imaging of testicular ischemia: quantitative and qualitative analyses in a rabbit model. Radiology. 239(3):718-29, 2006
                                          13. Vijayaraghavan SB: Sonographic differential diagnosis of acute scrotum: real-time whirlpool sign, a key sign of torsion. J Ultrasound Med. 25(5):563-74, 2006
                                          14. Wilbert DM et al: Evaluation of the acute scrotum by color-coded Doppler ultrasonography. J Urol. 149(6):1475-7, 1993