Decreased Blood Flow in the Testis: Is it Testicular Torsion?

Abstract

The absence of blood flow in the testis on ultrasound examination is the gold standard for diagnosis of testicular torsion. This imaging finding is seen in the vast majority of patients with testicular torsion, except in patients with partial torsion. Patients with partial testicular torsion may have reversal of arterial diastolic flow on spectral Doppler, decreased amplitude of the spectral Doppler waveform (parvus tardus wave), or monophasic waveforms. However, it is important to consider that not all absence of blood flow or reversal of diastolic flow in testis represents testicular torsion, as other conditions may have a similar appearance, including rare detection of such a pattern in normal asymptomatic patients. Conditions that commonly mimic testicular torsion include incarcerated inguinal hernias and complications following hernia repair,thrombotic phenomena, vasculitis, complicated epididymo-orchitis, asymptomatic variants, and technical limitations of ultrasonography. It is important for a practicing radiologist to be familiar with such cases to avoid unnecessary surgical interventions.We present a pictorial essay of cases in which the absence of testicular blood flow on color flow Doppler or abnormal waveforms on spectral Doppler are identified, without the presence of testicular torsion.

Çocuklarda Testis Torsiyonu: 10 Yıllık Retrospektif Bir Çalışma

“…It has been reported that sensitivity and specificity of color Doppler USG were 96-100% and 84-100% in diagnosis of torsion, respectively (16,17). Nuclear testicular flow studies performed as another technique for evaluation of blood flow of the testicles are not currently preferred since it is a long-lasting procedure and also not always available (18). The popularity of color Doppler USG has progressively increased because it is a non-invasive procedure and contributes to accurate diagnosis at least as much as nuclear scan.…”

Effects of Rosmarinus officinalis on orchitis following spermatic cord torsion‐detorsion in male mice with emphasis on anti‐ inflammatory and antioxidant properties

“…Also, the interstitial tissue is affected, leading to decreased levels of testosterone production by Leydig cells. Eventually, these pathological processes lead to testicular inflammation (Forrest et al., 2018). Any factor which inhibits the inflammation and increases the antioxidant level of cells can lead to the elimination of pathological complications and return the abnormal status of the testis to its normal and physiological activity.…”

Role of color flow Doppler ultrasound in the evaluation of acute scrotal pain

“…Note that an absence of Doppler signal within the testis is most commonly due to the spermatic cord's twisting. However, there are other potential etiologies for testicular ischemia, including vasculitis, drug‐mediated vasoconstriction, inguinal hernia or following inguinal hernia repair, and severe infection that is not responding to antibiotic therapy 25,26 . In these settings, the clinical history is of utmost importance.…”