This video shows a case of Testicular torsion.
In current practice, ultrasound is increasingly used to guide the diagnosis of testicular torsion, with reported 100% sensitivity, 97.9% specificity, and 98.1% diagnostic accuracy. Thus, ultrasonography served as the gold standard in our study population although constituting a 30 to 60-minute delay in diagnosis.
What is the whirlpool sign and why is it important? The whirlpool sign seen on ultrasound can indicate twisting of the spermatic cord, suggesting persistent testicular torsion, in both partial and complete cases. With acute testicular torsions, it can take several hours before ischemic damage is evident on ultrasound.1
Ultrasonography with color and power Doppler imaging has emerged as the primary imaging modality for the diagnosis of testicular torsion. It not only helps in corroborating the diagnosis by evaluation of the testicular echotexture but also provides valuable information on vascular perfusion of the testes.
Scrotal ultrasound is used to check blood flow. Decreased blood flow to the testicle is a sign of testicular torsion. But ultrasound doesn't always detect the reduced blood flow, so the test might not rule out testicular torsion
Intermittent torsion is defined as the sudden onset of unilateral testicular pain of short duration with spontaneous resolution.
Testicular torsion is a twisting of the spermatic cord and its contents and is a surgical emergency affecting 3.8 per 100,000 males younger than 18 years annually. It accounts for 10% to 15% of acute scrotal disease in children and results in an orchiectomy rate of 42% in boys undergoing surgery for testicular torsion. Immediate recognition and treatment are necessary, and torsion must be excluded in all patients who present with acute scrotum. Testicular torsion is a clinical diagnosis, and patients typically present with severe acute unilateral scrotal pain, nausea, and vomiting. Physical examination may reveal a high-riding testicle with an absent cremasteric reflex. If history and physical examination suggest torsion, immediate surgical exploration is indicated and should not be postponed to perform imaging studies. There is typically a four- to the eight-hour window before permanent ischemic damage occurs. A delay in treatment may be associated with decreased fertility or may necessitate orchiectomy.
Testicular torsion is a clinical diagnosis, and patients typically present with severe acute unilateral scrotal pain, nausea, and vomiting. Physical examination may reveal a high-riding testicle with an absent cremasteric reflex.
If the patient has testicular torsion, he'll feel sudden, possibly severe pain in his scrotum and one of his testicles. The pain can get worse or ease a bit, but probably won't go away completely. If a patient has sudden groin pain, get him to a hospital emergency room as soon as you can.
The scrotum should be examined for a tender spermatic cord, which is suggestive of epididymitis. A high-riding, transversely oriented testis is common with testicular torsion,17 whereas the testis is usually in its normal anatomic location with epididymitis and orchitis.
If you have a testicular torsion, chances are you'll know it. You'll feel a sudden, possibly severe pain in your scrotum and one of your testicles. The pain might increase and decrease but generally won't go away completely.
Signs and symptoms of testicular torsion include:
1). Sudden, severe pain in the scrotum.
2). Swelling of the scrotum, redness, tenderness, or hardening of the scrotum.
3). Nausea and vomiting.
4). Abdominal pain on the same side as the torsion.
5). The testicle is in a strange position, such as higher than normal or at an unusual angle.
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