Ultrasonography of intrascrotal torsed appendages: size and interval between symptom onset and the ultrasonographic examination according to echogenicity

Abstract

Purpose: The purpose of this study was to evaluate the size of the torsed appendages and the interval between the symptom onset and ultrasonographic performance according to the echogenicity of the torsed appendages.Methods: This was a retrospective analysis of 54 cases of 46 patients with torsion of the testicular appendages between December 2008 and July 2021. Eight patients performed follow-up ultrasonography after 7-48 days from initial ultrasonography. Ultrasonographic findings were determined by retrospective analysis of the images. The echogenicity, size, and degree of the blood flow of the torsed appendages and interval between symptom onset and US performance were determined based on the report. The echogenicity of torsed appendages was classified into three groups: hypoechoic, hyperechoic, or isoechoic.Results: Fifty-four torsed appendages showed hypoechoic (n = 40), hyperechoic (n = 9), and isoechoic (n = 5). The size of the torsed appendages ranged from 4 to 14 mm (8 ± 3.1 mm) in hypoechoic torsed appendages and 2.6 to 5 mm (3.7 ± 0.9 mm) in hyperechoic torsed appendages.The interval between symptom onset and ultrasonographic performance ranged from 0 to 17 days (4.2 ± 4.4 days) in hypoechoic torsed appendages and 8 to 48 days (29.8 ± 16 days) in hyperechoic torsed appendages. The hyperechoic torsed appendages had a small size and longer intervals between symptom onset and ultrasonographic performance than that of hypoechoic torsed appendages (< 0.05).Three hypoechoic torsed appendages and single isoechoic torsed appendage on initial ultrasonography changed into the hyperechoic on follow-up ultrasonography. Conclusion:The size of the torsed appendages and the interval between the symptom onset and ultrasonographic performance are different according to the echogenicity of the torsed appendages.The hyperechoic torsed appendages had smaller sizes and longer intervals than those of hypoechoic torsed appendages.