Torsion

torsion

Torsion. The testicle is attached to the scrotum at the bare area. If the bare area is small, a tiny remnant stalk of tunica vaginalis allows the testicle to be mobile. Torsion occurs when the testicle revolves one or more times on this short stalk, which obstructs blood flow to the testicle, resulting in severe pain. Torsion is more common in males under 25 years of age with a peak incidence at 13 years. Once torsion occurs, the testicle becomes congested and edematous because of the veins in the twisted cord. Pressure within the testicle then begins to build up because of the arterial obstruction which then leads to the testicular ischemia. It is important to diagnose this abnormality early because necrosis of the torsed testicle will occur within 24 hours.

Sonographically, a torsed testicle appears normal in the first four hours of torsion. Although the realtime appearance of the testes is normal, Color and pulsed-Doppler appearances are abnormal. There is an absence of flow in the testicle and the epididymis. After four hours, the torsed testicle appears enlarged and hypoechoic. The testicle may have some inhomogenous appearances as a result of hemorrhage. Other findings include enlargement of the epidiymis, a reactive hydrocele, and scrotal wall thickening.