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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
- Baldisserotto M: Scrotal emergencies. Pediatr Radiol. 39(5):516-21, 2009
- 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 V: Bell-clapper deformity. AJR Am J Roentgenol. 180(4):1176; author reply 1176-7, 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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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
- Baldisserotto M: Scrotal emergencies. Pediatr Radiol. 39(5):516-21, 2009
- 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 V: Bell-clapper deformity. AJR Am J Roentgenol. 180(4):1176; author reply 1176-7, 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
