Extravaginal torsion is generally found in neonates at the level of the spermatic cord, because the cord is poorly fixed in the inguinal canal. Because of this all the scrotal contents are strangulated. While extravaginal torsion most commonly occurs unilaterally, it does occur bilaterally however is an extremely rare event. Clinically the scrotum presents swollen and red with a firm, painless enlarged testicle, or testicles which is generally unilateral (Rumack 2011, p1948).
The ultrasound findings vary according to the duration of the torsion. In more recent torsion, the testis is heterogeneously enlarged with hypoechoic and hyperechoic areas (Rumack 2011, p 1948). When the torsion is more chronic, the testis may be normal or slightly enlarged in size, with peripheral echogenicity corresponding to calcifications in the tunica albuginea (Rumack p1948).
This ultrasound finding was of particular note at the time of the examination.
Scrotal skin thickening and hydroceles with debris and/or septations are common associated findings (Siegel Paediatric Sonography p 577).
Doppler signals are often absent in the testis and in the spermatic cord, although some flow may be seen with power Doppler imaging (Siegel Paediatrics Sonography p 577).