Abstract:The position and morphology of the head of the epididymis were abnormal in all boys with acute testicular torsion but with preserved testicular flow.
“…This finding is consistent with a previous report showing that the vast majority of patients with testicular torsion showed enlarged epididymal volume and hyperechogenicity on ultrasonography [9,11]. Galina et al [24] also focused on the abnormal configuration, size, and displaced position of the epididymis in patients with torsion and suggested that careful ultrasonographic evaluation of the epididymis may be useful as an adjunctive tool to diagnose testicular torsion. We demonstrated testicular hyperechogenicity and heterogeneity as early as 6 hours after complete torsion, but found no consistent patterns of echotexture change beyond 6 hours, whereas a previous study found that preoperative heterogeneous parenchymal echotexture indicated late torsion and testicular nonviability [10].…”
Purpose: We aimed to document the time of onset of ultrasonographic and histologic changes in the testes of a rat model following testicular torsion. Methods: Twenty-five Sprague-Dawley rats were divided into four groups. All animals underwent preoperative Doppler ultrasonography. Groups 1, 2, and 3 underwent unilateral surgical torsion of the testis lasting for 72, 24, and 6 hours, respectively. Group 4 underwent a sham operation. The animals were followed with Doppler ultrasonography at 6, 24, 48, and 72 hours postoperatively. Histologic examinations were performed at the designated final time point for each group. Results: After torsion, enlargement of the epididymal head and thickening of the spermatic cord over time were noted. Based on the ultrasonographic dimensions, the ratio of the epididymal volume increased with time following torsion (P=0.002). The torsed testes had an average weight gain of 0.27 g at 6 hours compared to the control testes, but an average weight loss of 0.22 g at 72 hours (P=0.006). Changes in testicular echotexture were noted as soon as 6 hours after torsion, but there was no consistent pattern of echotexture change thereafter. Histologically, viable tubules were seen 6 hours after torsion, while extensive hemorrhagic necrosis was found at 72 hours. Conclusion: In evaluating testicular torsion, the enlargement ratio of the epididymis and thickening of the spermatic cord on Doppler ultrasonography may be useful for determining the urgency of immediate surgery. Changes in testicular echotexture may not be a reliable indicator of the time of onset.
“…This finding is consistent with a previous report showing that the vast majority of patients with testicular torsion showed enlarged epididymal volume and hyperechogenicity on ultrasonography [9,11]. Galina et al [24] also focused on the abnormal configuration, size, and displaced position of the epididymis in patients with torsion and suggested that careful ultrasonographic evaluation of the epididymis may be useful as an adjunctive tool to diagnose testicular torsion. We demonstrated testicular hyperechogenicity and heterogeneity as early as 6 hours after complete torsion, but found no consistent patterns of echotexture change beyond 6 hours, whereas a previous study found that preoperative heterogeneous parenchymal echotexture indicated late torsion and testicular nonviability [10].…”
Purpose: We aimed to document the time of onset of ultrasonographic and histologic changes in the testes of a rat model following testicular torsion. Methods: Twenty-five Sprague-Dawley rats were divided into four groups. All animals underwent preoperative Doppler ultrasonography. Groups 1, 2, and 3 underwent unilateral surgical torsion of the testis lasting for 72, 24, and 6 hours, respectively. Group 4 underwent a sham operation. The animals were followed with Doppler ultrasonography at 6, 24, 48, and 72 hours postoperatively. Histologic examinations were performed at the designated final time point for each group. Results: After torsion, enlargement of the epididymal head and thickening of the spermatic cord over time were noted. Based on the ultrasonographic dimensions, the ratio of the epididymal volume increased with time following torsion (P=0.002). The torsed testes had an average weight gain of 0.27 g at 6 hours compared to the control testes, but an average weight loss of 0.22 g at 72 hours (P=0.006). Changes in testicular echotexture were noted as soon as 6 hours after torsion, but there was no consistent pattern of echotexture change thereafter. Histologically, viable tubules were seen 6 hours after torsion, while extensive hemorrhagic necrosis was found at 72 hours. Conclusion: In evaluating testicular torsion, the enlargement ratio of the epididymis and thickening of the spermatic cord on Doppler ultrasonography may be useful for determining the urgency of immediate surgery. Changes in testicular echotexture may not be a reliable indicator of the time of onset.
“…A partially twisted cord can have flow throughout its extent and might even look hyperemic (Fig. 4 ) [ 9 ]. Fig.…”
Section: Introductionmentioning
confidence: 99%
“…Both testicular MRI and contrast-enhanced sonography in the future might be a useful complement to clinical and baseline imaging in difficult/sonographically equivocal cases, although there are no prospective studies in the pediatric population [ 23 ]. In a retrospective study by Galina et al [ 9 ], the epididymis was always sonographically abnormal in boys with testicular torsion, being minimally or grossly displaced in relation to the testis and spermatic cord.…”
Testicular sonography has contributed greatly to the preoperative diagnosis of testicular torsion in the pediatric patient and is the mainstay for evaluation of acute scrotal pain. Despite its high sensitivity and specificity, both false-negative and false-positive findings occur. Presence of documented Doppler flow within the testis might be a dissuading factor for surgical exploration with resultant testicular loss in the false-negative cases. Our goal is to illustrate key sonographic features in the spectrum of testicular torsion with preserved testicular flow, and to describe how to differentiate testicular torsion from epididymitis in order to avoid the under-diagnosis of testicular torsion. We simplify the anatomy of the bell clapper testis. We also describe our sonographic protocol for testicular torsion and share valuable tips from our approach to challenging cases.Electronic supplementary materialThe online version of this article (10.1007/s00247-018-4093-0) contains supplementary material, which is available to authorized users.
“…Galina et al [23] showed that the position and morphology of the epididymal head were abnormal in all nine of the boys in that study with acute testicular torsion but preserved testicular flow. This was also true in four cases with apparently normal-looking spermatic cords.…”
Section: Testicular Torsionmentioning
confidence: 86%
“…Thus, observation of the epididymis is especially important in cases of incomplete torsion with preserved testicular flow. Additionally, reactive hydrocele and scrotal wall thickening may be seen [7,23,24]. …”
Urogenital emergencies are fairly common in the pediatric population, and a timely and correct diagnosis is necessary to avoid possible future infertility. In this field, ultrasonography is essential, as it has the advantages of being radiation-free and readily accessible. In particular, a high-frequency transducer allows precise evaluation of the morphology and vascularity of the scrotum, which is on the surface of the body. Beyond conventional techniques, new advanced imaging techniques have been developed, including elastography and contrast-enhanced ultrasonography. However, several pitfalls remain in the diagnosis of urogenital diseases using ultrasonography. Thus, accurate knowledge and sufficient experience with the technique are essential for making a correct diagnosis. This review provides an overview of pediatric urogenital emergency pathologies and recent ultrasonography techniques.
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