Seminars in Ultrasound, CT and MRI
Volume 28, Issue 4 , Pages 317-328 , August 2007

Testicular Torsion: Twists and Turns

  • E.P. Lin, MD
    • ,
  • S. Bhatt, MD
    • ,
  • D.J. Rubens, MD
    • ,
  • Vikram S. Dogra, MD

      Affiliations

    • Corresponding Author InformationAddress reprint requests to Vikram S. Dogra, MD, Professor of Radiology, Urology, and BME, University of Rochester School of Medicine, Department of Imaging Sciences, 601 Elmwood Ave., Box 648, Rochester, NY 14642.

References 

  1. Barada JH, Weingarten JL, Cromie WJ. Testicular salvage and age-related delay in the presentation of testicular torsion. J Urol. 1989;142:746–748
  2. Vijayaraghavan SB. Sonographic differential diagnosis of acute scrotum: real time whirlpool sign, a key sign of torsion. J Ultrasound Med. 2006;25:563–574
  3. Williamson RC. Torsion of the testis and allied conditions. Br J Surg. 1976;63:465–476
  4. Caesar RE, Kaplan GW. Incidence of the bell-clapper deformity in an autopsy series. Urology. 1994;44:114–116
  5. Dogra VS, Bhatt S, Rubens DJ. Sonographic evaluation of testicular torsion. Ultrasound Clin. 2006;1:55–66
  6. Washowich TL. Synchronous bilateral testicular torsion in an adult. J Ultrasound Med. 2001;20:933–935
  7. Pham SB, Hong MK, Teague JA, et al. Is the testis intraperitoneal?. Pediatr Surg Int. 2005;21:231–239
  8. Horstman WG, Middleton WD, Meslon GL, et al. Color Doppler US of the scrotum. Radiographics. 1991;11:941–957
  9. Dogra VS, Rubens DJ, Gottlieb RH, et al. Torsion and beyond: new twists in spectral Doppler evaluation of the scrotum. J Ultrasound Med. 2004;23:1077–1085
  10. Middleton WD, Thorne DA, Melson GL. Color Doppler ultrasound of the normal testis. AJR Am J Roentgenol. 1989;152:293–297
  11. Paltiel HJ, Connolly LP, Atala A, et al. Acute scrotal symptoms in boys with an indeterminate clinical presentation: comparison of color Doppler sonography and scintigraphy. Radiology. 1998;207:223–231
  12. Hawtrey CE. Assessment of acute scrotal symptoms and findings: a clinician’s dilemma. Urol Clin North Am. 1998;25:715–723
  13. Noske HD, Kraus SW, Altinkilic BM, et al. Historical milestones regarding torsion of the scrotal organs. J Urol. 1998;159:13–16
  14. Schulsinger D, Glassberg K, Strashun A. Intermittent torsion: association with horizontal lie of the testicle. J Urol. 1991;145:1053
  15. Rabinowitz R. The importance of the cremasteric reflex in acute scrotal swelling in children. J Urol. 1984;132:89
  16. Ciftci AO, Senocak ME, Tanyel FC, et al. Clinical predictors for differential diagnosis of acute scrotum. Eur J Pediatr Surg. 2004;14:333–338
  17. Favorito LA, Cavalcante AG, Costa WS. Anatomic aspects of epididymis and tunica vaginalis in patients with testicular torsion. Int Braz J Urol. 2004;30:20–424
  18. Sanelli PC, Burke BJ, Lee L. Color and spectral Doppler sonography of partial torsion of the spermatic cord. AJR Am J Roentgenol. 1999;172:49–51
  19. Ringdhal E, Teague L. Testicular torsion. Am Fam Physician. 2006;74:1739–1743
  20. Kamaledeen S, Surana R. Intermittent testicular pain: fix the testes. BJU Int. 2003;91:406–408
  21. Lee FT, Winter DB, Madsen FA, 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. 1996;167:785–790
  22. Dogra VS, Gottlieb RH, Oka M, et al. Sonography of the scrotum. Radiology. 2003;227:18–36
  23. Patriquin HB, Yazbeck S, Trinh B, et al. Testicular torsion in infants and children: diagnosis with Doppler sonography. Radiology. 1993;188:781–785
  24. Davenport M. ABC of general surgery in children (Acute problems of the scrotum). BMJ. 1996;312:435–537
  25. Middleton WD, Middleton MA, Dierks M, et al. Sonographic prediction of viability in testicular torsion: preliminary observations. J Ultrasound Med. 1997;16:23–27
  26. Lerner RM, Mevorach RA, Hulbert WC, et al. Color Doppler US in the evaluation of acute scrotal disease. Radiology. 1990;176(2):355–358
  27. Middleton WD, Siegel BA, Melson GL, et al. Acute scrotal disorders: prospective comparison of color Doppler US and testicular scintigraphy. Radiology. 1990;177(1):177–181
  28. Dogra VS, Bhatt S. Acute painful scrotum. Radiol Clin North Am. 2004;42(9):349–363
  29. Siegel MJ. The acute scrotum. Radiol Clin North Am. 1997;35:959–976
  30. Wilbert DM, Schaerfe CW, Stern WD, et al. Evaluation of the acute scrotum by color-coded Doppler ultrasonography. J Urol. 1993;149:1475–1477
  31. Bhatt S, Dogra VS. Doppler imaging of the uterus and adnexae. Ultrasound Clin. 2006;1(1):201–221
  32. Hamper UM, Dejong MR, Caskey CI, et al. Power Doppler imaging: clinical experience and correlation with color Doppler US and other imaging modalities. Radiographics. 1997;17:499–513
  33. Luker GD, Siegel MJ. Scrotal US in pediatric patients: comparison of power and standard color Doppler US. Radiology. 1996;198:381–385
  34. Burks DD, Markey BJ, Burkhard TK, et al. Suspected testicular torsion and ischemia: evaluation with color Doppler sonography. Radiology. 1990;175:815–821
  35. Scoutt LM, Zawin ML, Taylor KJ. Doppler US. Part II. Clinical applications. Radiology. 1990;174:309–319
  36. Berman JM, Beidle TR, Kunberger LE, et al. Sonographic evaluation of acute intrascrotal pathology. AJR Am J Roentgenol. 1996;166:857–861
  37. Nussbaum Blask AR, Rushton HG. Sonographic appearance of the epididymis in pediatric testicular torsion. AJR Am J Roentgenol. 2006;187:1627–1635
  38. Baud C, Veyrac C, Couture A, et al. Spiral twists of the spermatic cord: a reliable sign of testicular torsion. Pediatr Radiol. 1998;28:950–954
  39. Kalfa N, Veyrac C, Baud C, et al. Ultrasonography of the spermatic cord in children with testicular torsion: impact on the surgical strategy. J Urol. 2004;172:1692–1695
  40. Ozturk H, Ozturk H, Yagmur Y. PAF antagonist BN-52021 reduces intercellular adhesion molecule-1 expression and oxidative stress in rats with reperfusion damage due to unilateral testicular torsion. Pediatr Surg Int. 2006;22:191–196
  41. Adivarekar PK, Bhagwat SS, Raghavan V, et al. Effect of Lomomdex-MgSO4 in the prevention of reperfusion injury following unilateral testicular torsion: an experimental study in rats. Pediatr Surg Int. 2005;21:84–190
  42. Donohue RE, Utley WL. Torsion of spermatic cord. Urology. 1978;11:184–190
  43. Brown SM, Casillas VJ, Montalvo BM, et al. Intrauterine spermatic cord torsion in the newborn: sonographic and pathologic correlation. Radiology. 1990;177:755–757
  44. Dogra VS, Sessions A, Mevorach RA, et al. Reversal of diastolic plateau in partial testicular torsion. J Clin Ultrasound. 2001;29:105–108
  45. Sanelli PC, Burke BJ, Lee L. Color and spectral Doppler sonography of partial torsion of the spermatic cord. AJR Am J Roentgenol. 1999;172:49–51
  46. Philip J, Selvan D, Desmond AD. Mumps orchitis in the non-immune postpubertal male: a resurgent threat to male fertility?. BJU Int. 2006;97:138–141
  47. Somuncu S, Caskmak M, Erdogan S, et al. Protective effects of trapidil in ischemia-reperfusion injury due to testicular torsion and detorsion: an experimental study. Int J Urol. 2006;13:601–605
  48. Rubens DJ, Bhatt S, Nedleka S, et al. Doppler artifacts and pitfalls. Ultrasound Clin. 2006;1:79–109
  49. Suty JM, Hubert J, Duquenne M, et al. Bilateral testicular ischemia in vasculitis (Differential diagnosis with torsion and the value of color Doppler ultrasonography). Prog Urol. 1995;5:586–589
  50. Leibovici D, Strauss S, Sharon A. Acute, painful swollen testis in polyarteritis nodosa: a diagnostic problem. Harefuah. 1999;136:938–939
  51. Leung ML, Gooding GA, Williams RD. High-resolution sonography of scrotal contents in asymptomatic subjects. AJR Am J Roentgenol. 1984;143:161–164
  52. Nye PJ, Prati RC. Idiopathic hydrocele and absent testicular diastolic flow. J Clin Ultrasound. 1997;25:43–46
  53. Rolnick D, Kawanoue S, Szanto P, et al. Anatomical incidence of testicular appendages. J Urol. 1968;100:755–756
  54. Cohen HL, Shapiro MA, Haller JO, et al. Torsion of the testicular appendage (Sonographic diagnosis). J Ultrasound Med. 1992;11(3):81–83
  55. Skoglund RW, McRoberts JW, Ragde H. Torsion of testicular appendages. J Urol. 1970;104:598–600
  56. Hesser U, Rosenborg M, Gierup J, et al. Gray scale sonography in torsion of the testicular appendages. Pediatr Radiol. 1993;23:529–532
  57. Yang DM, Lim JW, Kim JE, et al. Torsed appendix testis (Gray scale appendix testis). J Ultrasound Med. 2005;24:87–91
  58. Sidhu PS. Clinical and imaging features of testicular torsion: role of ultrasound. Clin Radiol. 1999;54:343–352
  59. Coley BD, Frush DP, Babcock DS, et al. Acute testicular torsion: comparison of unenhanced and contrast-enhanced power Doppler US, color Doppler US, and radionuclide imaging. Radiology. 1996;199:441–446
  60. Paltiel HJ, Kalish LA, Susaeta RA, et al. Pulse-inversion US imaging of testicular ischemia: quantitative and qualitative analyses in a rabbit model. Radiology. 2006;239:718–729
  61. Watanabe Y, Dohke M, Ohkubo K, et al. Scrotal disorders: evaluation of testicular enhancement patterns at dynamic contrast-enhanced subtraction MR imaging. Radiology. 2000;217:219–227
  62. Capraro GA, Mader TJ, Coughlin BG, et al. Feasibility of using near-infrared spectroscopy to diagnose testicular torsion: an experimental study in sheep. [Abstract] Ann Emerg Med. 2007;49(4):520–525

PII: S0887-2171(07)00050-9

doi: 10.1053/j.sult.2007.05.008

Seminars in Ultrasound, CT and MRI
Volume 28, Issue 4 , Pages 317-328 , August 2007

Article Tools

* Image Usage & Resolution