The ultrasonographic “whirlpool sign” in testicular torsion: valuable tool or waste of valuable time? A systematic review and meta-analysis

Abstract

The WS, when correctly diagnosed, may be viewed as a very definitive sign for TT in the pediatric and adult populations. However, its role in neonates is limited.

Predictive value of haematologic parameters in diagnosis of testicular torsion: Evidence from a systematic review and meta‐analysis

“…Ultrasound is an effective imageological diagnosis and has been widely used (Ota et al, ). Besides, the positive whirlpool sign (WS) in ultrasonography was considered as a very definitive sign for TT among paediatric and adult patients (McDowall et al, ). Recently, magnetic resonance imaging (MRI) with minimum apparent diffusion coefficient (ADC) values can be used as an auxiliary examination in the diagnosis of partial TT (Beyazal et al, ; Ufuk, Herek, Herek, & Akbulut, ).…”

<p>Testicular Torsion in the Emergency Room: A Review of Detection and Management Strategies</p>

“…36 A recent meta-analysis to determine the accuracy of the whirlpool sign observed a pooled sensitivity of 92% (95% CI, 0.70-0.98), a pooled specificity of 99% (95% CI, 0.95-1.00) and a summary estimate log odds ratio of 5.32 (95% CI, 1.59-9.05; p=0.001) in adults and nonneonatal pediatric patients. 37 Another sign that may be visualized on ultrasonography is the redundant spermatic cord sign, where the spermatic cord appears torturous, indicating an abnormality in the attachment of the tunica vaginalis. 27 In the setting of an acute scrotum, this sign may be seen as a boggy pseudo mass or a torsion knot (Figure 2).…”

Role of the ultrasonographic ‘whirlpool sign’ in intestinal volvulus: a systematic review and meta‐analysis

“…44 From the 16 articles included, 12 concluded that the US WS is a valuable tool in the diagnosis of IV, while the remaining four 12,17,23,25 concluded that the sign was of limited value. 48 The pooled sensitivity of the US WS in diagnosing IV of 87.42% (95% CI: 81.05-92.25) from the nine studies that were included in the meta-analysis is less than ideal. They further reported that the WS was noted in some individuals without volvulus (10 patients with intestinal obstruction from post-surgical adhesions and one patient with mesenteric lymphadenopathy secondary to leukaemia).…”

“…45 Other pathological conditions where the WS has also been described include omental torsion 46 enteritis, megacolon, 44 ovarian torsion 47 and testicular torsion. 48 The pooled sensitivity of the US WS in diagnosing IV of 87.42% (95% CI: 81.05-92.25) from the nine studies that were included in the meta-analysis is less than ideal. Hence, other diagnostic modalities must be considered when the sign is absent.…”