Dr Arun Gupta Director imaging

Dr Rakhee gupta Dr R K S Gandhi Dr Vinayak Mittal Dr Ritesh Mahajan

TORSION TESTIS

TORSION TESTIS

Torsion is more common in boys than in men, and itrepresents only 20% of the acute scrotal pathologic

phenomena in postpubertal males. However, prompt diagnosis is necessary because torsion

requires immediate surgery to preserve the testis. Acute Sub-Acute Chronic ------------------ Intra- VaginalExtra -Vaginal

NORMAL TORSION

The tunica vaginalis does not completely surround the testis and epididymis, which are attached to the posteriorscrotal wall .

Bell-clapper anomaly. The tunica vaginalis completely surrounds the testis, epididymis,and part of the spermatic cord, predisposing to torsion.

Intravaginal torsion. Bell-clapper anomaly with complete torsion of the spermatic cord, compromising the blood supply to the testis.

Extravaginal torsion in a neonate. Tunica vaginalis is in normal position, but abnormal motility allows rotation of the testis, epididymis, and spermatic cord.

NORMAL ORIENTATION OF THE RT SIDE

TESTIS IS APPRECIATED

AND

CHANGE IN THE LONG AXIS OF THE LEFT SIDE TESTIS

IS SEQUEL TO TORSION

( BELL CLAPPER MORPHOLOGY) .

NORMAL TORSION SEQUAEL

COMPARISON BETWEEN NORMAL

AND ISCHEMIC TESTIS .

NORMAL RT TESTIS HAS MIDLEVEL ECHOES OF THE PARENCHYMA WITH SLOW FLOW VASCULARITY .

HYPOECHOIC / HETEROGENOUS ECHOGENECITY OF LEFT TESTIS ( EARLY TORSION).

HYPERECHOIC ECOPATTERN CAN BE SEEN WITH INFARCTION / HAEMORRHAGE ALSO NORMAL

TESTIS

TORSION SEQUAEL

NORMAL INTRAPARENCHYMAL

VASCULARITY

CORD TESTIS EPIDYDIMIS COMPLEX

1. EPIDYDIMIS may be enlarged and can not

be appreciated as separate from the

cord leading to formation of

CORD / EPIDYDIMIS COMPLEX.

2. EXTRATESTICULAR MASS CAN BE SEQUAEL TO

HAEMORRGAE IN EPIDYDIMIS /

TUNICA VAGINALIS

Circumferential swirl of the vessels is appreciated proximal to the torison site . Distal to the swirl there

is no color fill .

TORSION KNOT The spermatic cord immediately proximal to the testis and epididymis is twisted, causing a

characteristic torsion knot or “whirlpool pattern” of concentric layers.

HIGH RESISTANCE ARTERIAL FLOW IS APPRECIATED JUST PROXIMAL TO THE TORISON SITE

REACTIONARY INCREASE IN THE THICKNESS OF THE SCROTAL SUBCUTIS PLANE WTH INCREASED VASCULARITY OF THE PARATESTICULAR TISSUES ( DARTOS FASCIA )

TORSION TESTIS

In torsion,blood flow is absent in the affected testicle or significantly less than in the normal, contralateral testicle.

NO BLOOD FLOW IS APPRECIATED IN THE EPIDYDIMIS /TESTIS COMPLEX DISTAL TO SWIRL OF BLOOD FLOW REPRESENTING THE TORSION SITE

TORSION KNOT

POST ORCHIDOPEXY IMAGES BOTH TESTIS HAVE NEAR

NORMAL COMPARABLE ECHOPATTERN

Potential pitfalls ….while diagnosing torsion

PARTIAL TORSION : Torsion of at least 540 degrees is necessary for complete arterial occlusion .With partial torsion of 360 degrees, or less, arterial flow may still occur, but venous outflow is often obstructed causing diminished diastolic arterial flow on spectralDoppler examination.

TORSION/DETORSION :If spontaneous detorsion occurs, flow

within the affected testis may be normal, or it may be increased and mimic orchitis. Spontaneous detorsion rarely occurs and leaves a segmental testicular infarction.

ISCHEMIA FROM ORCHITIS :Segmental testicular infarction

may also occur with Henoch-Schönlein purpura or with orchitis . Orchitis may also cause global ischemia of the testis and mimic torsion.

REFERENCE

DIAGNOSTICULTRASOUNDFOURTH EDITIONCarol M. Rumack, MD, FACRJ. William Charboneau, MD, FACRDeborah Levine, MD, FACR