Sonographic Differential Diagnosis of Acute Scrotum

Abstract

Sonography of acute scrotum should include study of the spermatic cord. The sonographic real-time whirlpool sign is the most specific and sensitive sign of torsion, both complete and incomplete. Intermittent testicular torsion is a challenging clinical condition with a spectrum of clinical and sonographic features.

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“…False-negative Doppler evaluations can also occur in the setting of spontaneous detorsion or intermittent torsion [15]. Intermittent torsion can exhibit hyperemia [16] and may be misdiagnosed as orchitis. A horizontal testicular position [17,18] and episodes of pain relief are useful for making a correct diagnosis.…”

“…The most direct finding with respect to testicular torsion is a twisted spermatic cord, referred to as the “whirlpool sign” (Fig. 1C, D) [16]. Indeed, the sensitivity and specificity of the whirlpool sign are up to 100% [16,21,22].…”

“…1C, D) [16]. Indeed, the sensitivity and specificity of the whirlpool sign are up to 100% [16,21,22]. The whirlpool sign is also useful in cases of incomplete torsion, in which testicular vascularity may be preserved.…”

“…Thus, the whirlpool sign should be carefully sought to avoid this pitfall, even if testicular vascularity is preserved. The location of the twisted spermatic cord varies: from just distal to the external ring to above or posterior to the testis [16]. In the case of an undescended testis, a twisted spermatic cord may be located in the inguinal canal.…”

“…In the case of an undescended testis, a twisted spermatic cord may be located in the inguinal canal. Thus, the entire route should be screened when seeking a twisted spermatic cord [16]. …”