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Pelvis » Scrotum And Testicles
Left testicular and epididymal torsion
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Author(s) :
Chaitali Shah, FRCR
 
Presentation A 25 year old man presents with severe, acute left scrotal pain of a few hours duration. The onset was sudden and not preceded by trauma. A scrotal ultrasound was performed.
 
 
 
Caption: Transverse image of the left testis and epididymis
Description: The left testis appears normal in size and shows a homogeneous parenchymal echotexture. The left epididymis however appears enlarged and shows a heterogeneous appearance.
 
 
 
Caption: Midline transverse scan.
Description: Both the testes are seen in this image and appear normal in size. The left epididymis appears enlarged.
 
 
 
Caption: Color Doppler image of the left scrotal contents.
Description: This image demonstrates the striking absence of the normal color flow in the left testis and epididymis.
 
 
 
Caption: Spectral Doppler analysis of the right side.
Description: The right testis and epididymis show normal color flow and a normal arterial waveform.
 
 
 
Caption: Midline color Doppler image.
Description: The right testis shows normal color flow pattern. The left testis shows no color flow.
 
Differential Diagnosis Left testicular and epididymal torsion.
 
Final Diagnosis Left testicular and epididymal torsion.
 
Follow Up This patient underwent an emergent bilateral scrotal exploration. Upon de-torsion of the left testis and epididymis at surgery, they appeared  normal and pink in color and not gangrenous. Therefore, a bilateral subtunical pouch orchidopexy was performed.
 
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