Case Review: Ultrasound of Testicular Torsion
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- Опубліковано 15 лип 2024
- In this radiology lecture, we review the ultrasound appearance of testicular torsion through three unique cases.
Key teaching points include:
1) Torsion occurs when spermatic cord twists and cuts off blood supply to the testis.
2) Bell-clapper deformity most common etiology: Abnormally high attachment of tunica vaginalis allowing spermatic cord rotation and testicular torsion (intravaginal).
3) Torsion has a bimodal distribution: First year of life (extravaginal), adolescents/young adults (intravaginal).
4) “Whirlpool” sign: Eddy swirl of coiled spermatic cord superior to testis, highly specific but less commonly seen than redundant spermatic cord.
5) Redundant spermatic cord AKA boggy pseudomass, torsion knot, epididymal-cord complex and should be avascular or only minimally vascular (unlike paratesticular neoplasm or acute epididymitis).
6) Testicles normally lie vertically, but horizontal or oblique (diagonal) lie suspicious for torsion.
7) Testicular enlargement, reactive hydrocele and scrotal skin thickening are secondary findings of torsion.
8) Marked testicular heterogeneity = Late torsion and nonviability/necrosis, more likely after 24 hours of symptoms).
9) Treatment: Detorsion and orchiopexy if salvageable, orchiectomy if not.
Reference: Bandarkar AN, Blask AR. Testicular torsion with preserved flow: Key sonographic features and value-added approach to diagnosis. Pediatric Radiology (2018) 48:735-744.
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Top notch radiology content. Outstanding as always
Great to hear, thank you!
a flawless work, as usual. respect.
Thank you for that feedback, much appreciated!
Brilliant and amazing content, thank you
Much appreciated, thank you for the feedback!
Very useful , thanks for the superb work
Appreciate that, glad you found it useful!
Thank you for sharing these excellent cases.
My pleasure!
Very good work
Thank you, much appreciated.
thanks sir,
Most welcome!
good job
Thank you!
Great video sir!
How do I differentiate subacute torsion from epididymo-orchitis sir?
Thank you! Subacute/intermittent torsion may have abnormal testicular waveforms, such as loss of venous flow, dampened arterial diastolic and peaked arterial systolic flow. Also, the epididymitis typically isn't hyperemic with testicular torsion as it would be with epididymitis. But it can sometimes be difficult to differentiate, especially if there is orchitis complicated by venous infarcts.
I sometimes have pain in my pubic area but not in Scrotum is it linked to testicle please tell me 😢
Sir can you fine at ultra sound about bell clapper defomilty?
We usually see the secondary features of bell clapper deformity when torsion occurs, rather than the deformity itself. It's the most common cause of torsion in adolescents and young adults, unlike the type of torsion that occurs in neonates at the level of the external inguinal ring.
i have a complaint. Not enough videos
I'm working on a few projects right now, and I apologize that the video frequency has decreased. In the upcoming months I hope to increase those video numbers, so please stay tuned Nikhil!
Please dont apologize. It takes time and effort to churn out quality content such as this. Really appreciate the effort that you put. Would really like to collab with you someday.
Very good work
Thank you so much.