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Testicular Torsion
Bryan R. Foster, MD; Shweta Bhatt, MD
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KEY FACTS

  • Terminology

    • Imaging

      • Pathology

        • Clinical Issues

          TERMINOLOGY

          • Definitions

            • Spontaneous or traumatic twisting of testis and spermatic cord within scrotum, resulting in vascular occlusion/infarction

          IMAGING

          • General Features

            • Ultrasonographic Findings

              • MR 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

                                          1. Hosokawa T et al: Diagnostic accuracy of ultrasound for the directionality of testicular rotation and the degree of spermatic cord twist in pediatric patients with testicular torsion. J Ultrasound Med. 39(1):119-26, 2020
                                          2. Afsarlar CE et al: Novel prognostic grayscale ultrasonographic findings in the testis from a comprehensive analysis of pediatric patients with testicular torsion. J Pediatr Urol. 15(5):480.e1-480.e7, 2019
                                          3. Expert Panel on Urological Imaging:. et al: ACR Appropriateness Criteria┬« Acute Onset of Scrotal Pain-Without Trauma, Without Antecedent Mass. J Am Coll Radiol. 16(5S):S38-S43, 2019
                                          4. Kargl S et al: Torsion of an undescended testis - A surgical pediatric emergency. J Pediatr Surg. ePub, 2019
                                          5. Ota K et al: The role of ultrasound imaging in adult patients with testicular torsion: a systematic review and meta-analysis. J Med Ultrason (2001). 46(3):325-34, 2019
                                          6. Sweet DE et al: Imaging of the acute scrotum: keys to a rapid diagnosis of acute scrotal disorders. Abdom Radiol (NY). 45(7):2063-81, 2020
                                          7. Rebik K et al: Scrotal ultrasound. Radiol Clin North Am. 57(3):635-48, 2019
                                          8. Bertolotto M et al: Multiparametric US for scrotal diseases. Abdom Radiol (NY). 43(4):899-917, 2018
                                          9. McDowall J et al: The ultrasonographic "whirlpool sign" in testicular torsion: valuable tool or waste of valuable time? A systematic review and meta-analysis. Emerg Radiol. 25(3):281-92, 2018
                                          10. Osumah TS et al: Frontiers in pediatric testicular torsion: An integrated review of prevailing trends and management outcomes. J Pediatr Urol. 14(5):394-401, 2018
                                          11. Bertolotto M et al: Pitfalls in Imaging for Acute Scrotal Pathology. Semin Roentgenol. 51(1):60-9, 2016
                                          12. 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
                                          13. Avery LL et al: Imaging of penile and scrotal emergencies. Radiographics. 33(3):721-40, 2013
                                          14. Yusuf GT et al: A review of ultrasound imaging in scrotal emergencies. J Ultrasound. 16(4):171-8, 2013
                                          15. Prando D: Torsion of the spermatic cord: the main gray-scale and doppler sonographic signs. Abdom Imaging. 34(5):648-61, 2009
                                          16. Bhatt S et al: Role of US in testicular and scrotal trauma. Radiographics. 28(6):1617-29, 2008
                                          17. Pepe P et al: Does color Doppler sonography improve the clinical assessment of patients with acute scrotum? Eur J Radiol. 60(1):120-4, 2006
                                          18. 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
                                          19. Dogra VS et al: Sonography of the scrotum. Radiology. 227(1):18-36, 2003
                                          20. Arce JD et al: Sonographic diagnosis of acute spermatic cord torsion. Rotation of the cord: a key to the diagnosis. Pediatr Radiol. 32(7):485-91, 2002
                                          21. Lee FT Jr et al: Conventional color Doppler velocity sonography versus color Doppler energy sonography for the diagnosis of acute experimental torsion of the spermatic cord. AJR Am J Roentgenol. 167(3):785-90, 1996
                                          Related Anatomy
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                                          Related Differential Diagnoses
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                                          References
                                          Tables

                                          Tables

                                          KEY FACTS

                                          • Terminology

                                            • Imaging

                                              • Pathology

                                                • Clinical Issues

                                                  TERMINOLOGY

                                                  • Definitions

                                                    • Spontaneous or traumatic twisting of testis and spermatic cord within scrotum, resulting in vascular occlusion/infarction

                                                  IMAGING

                                                  • General Features

                                                    • Ultrasonographic Findings

                                                      • MR 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

                                                                                  1. Hosokawa T et al: Diagnostic accuracy of ultrasound for the directionality of testicular rotation and the degree of spermatic cord twist in pediatric patients with testicular torsion. J Ultrasound Med. 39(1):119-26, 2020
                                                                                  2. Afsarlar CE et al: Novel prognostic grayscale ultrasonographic findings in the testis from a comprehensive analysis of pediatric patients with testicular torsion. J Pediatr Urol. 15(5):480.e1-480.e7, 2019
                                                                                  3. Expert Panel on Urological Imaging:. et al: ACR Appropriateness Criteria┬« Acute Onset of Scrotal Pain-Without Trauma, Without Antecedent Mass. J Am Coll Radiol. 16(5S):S38-S43, 2019
                                                                                  4. Kargl S et al: Torsion of an undescended testis - A surgical pediatric emergency. J Pediatr Surg. ePub, 2019
                                                                                  5. Ota K et al: The role of ultrasound imaging in adult patients with testicular torsion: a systematic review and meta-analysis. J Med Ultrason (2001). 46(3):325-34, 2019
                                                                                  6. Sweet DE et al: Imaging of the acute scrotum: keys to a rapid diagnosis of acute scrotal disorders. Abdom Radiol (NY). 45(7):2063-81, 2020
                                                                                  7. Rebik K et al: Scrotal ultrasound. Radiol Clin North Am. 57(3):635-48, 2019
                                                                                  8. Bertolotto M et al: Multiparametric US for scrotal diseases. Abdom Radiol (NY). 43(4):899-917, 2018
                                                                                  9. McDowall J et al: The ultrasonographic "whirlpool sign" in testicular torsion: valuable tool or waste of valuable time? A systematic review and meta-analysis. Emerg Radiol. 25(3):281-92, 2018
                                                                                  10. Osumah TS et al: Frontiers in pediatric testicular torsion: An integrated review of prevailing trends and management outcomes. J Pediatr Urol. 14(5):394-401, 2018
                                                                                  11. Bertolotto M et al: Pitfalls in Imaging for Acute Scrotal Pathology. Semin Roentgenol. 51(1):60-9, 2016
                                                                                  12. 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
                                                                                  13. Avery LL et al: Imaging of penile and scrotal emergencies. Radiographics. 33(3):721-40, 2013
                                                                                  14. Yusuf GT et al: A review of ultrasound imaging in scrotal emergencies. J Ultrasound. 16(4):171-8, 2013
                                                                                  15. Prando D: Torsion of the spermatic cord: the main gray-scale and doppler sonographic signs. Abdom Imaging. 34(5):648-61, 2009
                                                                                  16. Bhatt S et al: Role of US in testicular and scrotal trauma. Radiographics. 28(6):1617-29, 2008
                                                                                  17. Pepe P et al: Does color Doppler sonography improve the clinical assessment of patients with acute scrotum? Eur J Radiol. 60(1):120-4, 2006
                                                                                  18. 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
                                                                                  19. Dogra VS et al: Sonography of the scrotum. Radiology. 227(1):18-36, 2003
                                                                                  20. Arce JD et al: Sonographic diagnosis of acute spermatic cord torsion. Rotation of the cord: a key to the diagnosis. Pediatr Radiol. 32(7):485-91, 2002
                                                                                  21. Lee FT Jr et al: Conventional color Doppler velocity sonography versus color Doppler energy sonography for the diagnosis of acute experimental torsion of the spermatic cord. AJR Am J Roentgenol. 167(3):785-90, 1996