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KEY FACTS
Terminology
Imaging
Top Differential Diagnoses
Pathology
Clinical Issues
TERMINOLOGY
Synonyms
Torsion, late or "missed" torsion, acute scrotum
Definitions
Spontaneous or traumatic twisting of testis & spermatic cord within scrotum → vascular occlusion/infarction
Testicle twists medially in 2/3 of cases, so manual detorsion laterally more likely to be effective
Direction of manual detorsion described as "opening book"
IMAGING
General Features
Ultrasonographic Findings
Nuclear Medicine Findings
Imaging Recommendations
DIFFERENTIAL DIAGNOSIS
PATHOLOGY
General Features
Staging, Grading, & Classification
Gross Pathologic & Surgical Features
Microscopic Features
CLINICAL ISSUES
Presentation
Demographics
Natural History & Prognosis
Treatment
DIAGNOSTIC CHECKLIST
Consider
Image Interpretation Pearls
Selected References
Fenton LZ et al: Sonography of pediatric blunt scrotal trauma: what the pediatric urologist wants to know. Pediatr Radiol. 46(7):1049-58, 2016
Friedman AA et al: Standardized education and parental awareness are lacking for testicular torsion. J Pediatr Urol. S1477-5131(16)00021-8. 2016
Gielchinsky I et al: Pregnancy rates after testicular torsion. J Urol. S0022-5347(16)30285-3, 2016
Sauvestre F et al: Prenatal testicular torsion: not always in the late third trimester. Urology. 89:132-3, 2016
Sheth KR et al: Diagnosing testicular torsion before urological consultation and imaging: validation of the TWIST score. J Urol. 195(6):1870-6 2016
Wongwaisayawan S et al: Magnetic resonance of pelvic and gastrointestinal emergencies. Magn Reson Imaging Clin N Am. 24(2):419-31, 2016
Riccabona M et al: ESPR Uroradiology Taskforce--imaging recommendations in paediatric uroradiology, part VIII: retrograde urethrography, imaging disorder of sexual development and imaging childhood testicular torsion. Pediatr Radiol. 45(13):2023-8, 2015
Esposito F et al: The "whirlpool sign", a US finding in partial torsion of the spermatic cord: 4 cases. J Ultrasound. 17(4):313-5, 2014
Dajusta DG et al: Contemporary review of testicular torsion: new concepts, emerging technologies and potential therapeutics. J Pediatr Urol. 9(6 Pt A):723-30, 2012
Cost NG et al: Pediatric testicular torsion: demographics of national orchiopexy versus orchiectomy rates. J Urol. 185(6 Suppl):2459-63, 2011
Molokwu CN et al: Outcomes of scrotal exploration for acute scrotal pain suspicious of testicular torsion: a consecutive case series of 173 patients. BJU Int. 107(6):990-3, 2011
Moore CP et al: Cryptorchid testicular torsion. Pediatr Emerg Care. 27(2):121-3, 2011
Chmelnik M et al: Testicular torsion: sonomorphological appearance as a predictor for testicular viability and outcome in neonates and children. Pediatr Surg Int. 26(3):281-6, 2010
Waldert M et al: Color Doppler sonography reliably identifies testicular torsion in boys. Urology. 75(5):1170-4, 2010
Yagil Y et al: Role of Doppler ultrasonography in the triage of acute scrotum in the emergency department. J Ultrasound Med. 29(1):11-21, 2010
Fukuda S et al: Idiopathic testicular infarction in a boy initially suspected to have acute epididymo-orchitis associated with mycoplasma infection and Henoch-Schönlein purpura. J Pediatr Urol. 5(1):68-71, 2009
Ciftci AO et al: Clinical predictors for differential diagnosis of acute scrotum. Eur J Pediatr Surg. 14(5):333-8, 2004
Dogra V et al: Acute painful scrotum. Radiol Clin North Am. 42(2):349-63, 2004
Kalfa N et al: Ultrasonography of the spermatic cord in children with testicular torsion: impact on the surgical strategy. J Urol. 172(4 Pt 2):1692-5; discussion 1695, 2004
Matsumoto A et al: Torsion of the hernia sac within a hydrocele of the scrotum in a child. Int J Urol. 11(9):789-91, 2004
Sorensen MD et al: Prenatal bilateral extravaginal testicular torsion--a case presentation. Pediatr Surg Int. 20(11-12):892-3, 2004
Candocia FJ et al: An infant with testicular torsion in the inguinal canal. Pediatr Radiol. 33(10):722-4, 2003
Diamond DA et al: Neonatal scrotal haematoma: mimicker of neonatal testicular torsion. BJU Int. 91(7):675-7, 2003
Dogra VS et al: Sonography of the scrotum. Radiology. 227(1):18-36, 2003
Kamaledeen S et al: Intermittent testicular pain: fix the testes. BJU Int. 91(4):406-8, 2003
Nelson CP et al: The cremasteric reflex: a useful but imperfect sign in testicular torsion. J Pediatr Surg. 38(8):1248-9, 2003
Sessions AE et al: Testicular torsion: direction, degree, duration and disinformation. J Urol. 169(2):663-5, 2003
Stehr M et al: Critical validation of colour Doppler ultrasound in diagnostics of acute scrotum in children. Eur J Pediatr Surg. 13(6):386-92, 2003
Traubici J et al: Original report. Testicular torsion in neonates and infants: sonographic features in 30 patients. AJR Am J Roentgenol. 180(4):1143-5, 2003
Related Anatomy
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Related Differential Diagnoses
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References
Tables
Tables
KEY FACTS
Terminology
Imaging
Top Differential Diagnoses
Pathology
Clinical Issues
TERMINOLOGY
Synonyms
Torsion, late or "missed" torsion, acute scrotum
Definitions
Spontaneous or traumatic twisting of testis & spermatic cord within scrotum → vascular occlusion/infarction
Testicle twists medially in 2/3 of cases, so manual detorsion laterally more likely to be effective
Direction of manual detorsion described as "opening book"
IMAGING
General Features
Ultrasonographic Findings
Nuclear Medicine Findings
Imaging Recommendations
DIFFERENTIAL DIAGNOSIS
PATHOLOGY
General Features
Staging, Grading, & Classification
Gross Pathologic & Surgical Features
Microscopic Features
CLINICAL ISSUES
Presentation
Demographics
Natural History & Prognosis
Treatment
DIAGNOSTIC CHECKLIST
Consider
Image Interpretation Pearls
Selected References
Fenton LZ et al: Sonography of pediatric blunt scrotal trauma: what the pediatric urologist wants to know. Pediatr Radiol. 46(7):1049-58, 2016
Friedman AA et al: Standardized education and parental awareness are lacking for testicular torsion. J Pediatr Urol. S1477-5131(16)00021-8. 2016
Gielchinsky I et al: Pregnancy rates after testicular torsion. J Urol. S0022-5347(16)30285-3, 2016
Sauvestre F et al: Prenatal testicular torsion: not always in the late third trimester. Urology. 89:132-3, 2016
Sheth KR et al: Diagnosing testicular torsion before urological consultation and imaging: validation of the TWIST score. J Urol. 195(6):1870-6 2016
Wongwaisayawan S et al: Magnetic resonance of pelvic and gastrointestinal emergencies. Magn Reson Imaging Clin N Am. 24(2):419-31, 2016
Riccabona M et al: ESPR Uroradiology Taskforce--imaging recommendations in paediatric uroradiology, part VIII: retrograde urethrography, imaging disorder of sexual development and imaging childhood testicular torsion. Pediatr Radiol. 45(13):2023-8, 2015
Esposito F et al: The "whirlpool sign", a US finding in partial torsion of the spermatic cord: 4 cases. J Ultrasound. 17(4):313-5, 2014
Dajusta DG et al: Contemporary review of testicular torsion: new concepts, emerging technologies and potential therapeutics. J Pediatr Urol. 9(6 Pt A):723-30, 2012
Cost NG et al: Pediatric testicular torsion: demographics of national orchiopexy versus orchiectomy rates. J Urol. 185(6 Suppl):2459-63, 2011
Molokwu CN et al: Outcomes of scrotal exploration for acute scrotal pain suspicious of testicular torsion: a consecutive case series of 173 patients. BJU Int. 107(6):990-3, 2011
Moore CP et al: Cryptorchid testicular torsion. Pediatr Emerg Care. 27(2):121-3, 2011
Chmelnik M et al: Testicular torsion: sonomorphological appearance as a predictor for testicular viability and outcome in neonates and children. Pediatr Surg Int. 26(3):281-6, 2010
Waldert M et al: Color Doppler sonography reliably identifies testicular torsion in boys. Urology. 75(5):1170-4, 2010
Yagil Y et al: Role of Doppler ultrasonography in the triage of acute scrotum in the emergency department. J Ultrasound Med. 29(1):11-21, 2010
Fukuda S et al: Idiopathic testicular infarction in a boy initially suspected to have acute epididymo-orchitis associated with mycoplasma infection and Henoch-Schönlein purpura. J Pediatr Urol. 5(1):68-71, 2009
Ciftci AO et al: Clinical predictors for differential diagnosis of acute scrotum. Eur J Pediatr Surg. 14(5):333-8, 2004
Dogra V et al: Acute painful scrotum. Radiol Clin North Am. 42(2):349-63, 2004
Kalfa N et al: Ultrasonography of the spermatic cord in children with testicular torsion: impact on the surgical strategy. J Urol. 172(4 Pt 2):1692-5; discussion 1695, 2004
Matsumoto A et al: Torsion of the hernia sac within a hydrocele of the scrotum in a child. Int J Urol. 11(9):789-91, 2004
Sorensen MD et al: Prenatal bilateral extravaginal testicular torsion--a case presentation. Pediatr Surg Int. 20(11-12):892-3, 2004
Candocia FJ et al: An infant with testicular torsion in the inguinal canal. Pediatr Radiol. 33(10):722-4, 2003
Diamond DA et al: Neonatal scrotal haematoma: mimicker of neonatal testicular torsion. BJU Int. 91(7):675-7, 2003
Dogra VS et al: Sonography of the scrotum. Radiology. 227(1):18-36, 2003
Kamaledeen S et al: Intermittent testicular pain: fix the testes. BJU Int. 91(4):406-8, 2003
Nelson CP et al: The cremasteric reflex: a useful but imperfect sign in testicular torsion. J Pediatr Surg. 38(8):1248-9, 2003
Sessions AE et al: Testicular torsion: direction, degree, duration and disinformation. J Urol. 169(2):663-5, 2003
Stehr M et al: Critical validation of colour Doppler ultrasound in diagnostics of acute scrotum in children. Eur J Pediatr Surg. 13(6):386-92, 2003
Traubici J et al: Original report. Testicular torsion in neonates and infants: sonographic features in 30 patients. AJR Am J Roentgenol. 180(4):1143-5, 2003
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