{"id":1363,"date":"2018-11-21T20:22:26","date_gmt":"2018-11-21T20:22:26","guid":{"rendered":"http:\/\/emultrasound.sdsc.edu\/?p=1363"},"modified":"2020-07-21T23:53:53","modified_gmt":"2020-07-21T23:53:53","slug":"testicular-torsion","status":"publish","type":"post","link":"https:\/\/emultrasound.ucsd.edu\/index.php\/2018\/11\/21\/testicular-torsion\/","title":{"rendered":"Case # 14: Whirlpool swirling, twisting and turning"},"content":{"rendered":"
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A 13-year-old male presents to the emergency department with right testicular pain for one-hour duration. The pain began while having a bowel movement. He had no nausea or vomiting. His exam is notable for a high riding right testicle and tenderness to palpation over the right testicle.<\/p>\n

Vitals: T: 97.8, HR: 106, BP: 135\/79, RR: 16, Sat: 96% on RA<\/p>\n

A bedside ultrasound of the testicles is performed. What do you see?<\/p>\n

\"\"<\/p>\n<\/div>\n<\/div>\n<\/div>\n

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\n<\/div>\n<\/div>\n
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Answer and Learning Points<\/h3>
\n

Answer<\/strong><\/p>\n

These ultrasound images demonstrates limited flow into the right testicle suggestive of testicular torsion. Manual detorsion was performed at the bedside using the \u201copen-the-book\u201d maneuver with subsequent ultrasound demonstrating return of flow to the right testicle. Urology was consulted, and the patient was scheduled for an outpatient orchiopexy.<\/p>\n

Learning Points<\/strong><\/p>\n

The acute scrotum is a presentation that requires timely evaluation and management by the emergency physician. Of all causes of acute scrotum, testicular torsion is the diagnosis that requires the most emergent action because of the limited time window of testicular salvageability.1<\/sup> Unfortunately, in many clinical settings including urgent cares, clinics, and rural community emergency rooms, it can be challenging to confirm our clinical suspicion in a timely fashion because of the difficulty in obtaining an official scrotal ultrasound. For this reason, POCUS is an important tool for emergency physicians in the diagnosis of patients with acute scrotum.<\/p>\n

Ultrasound findings of testicular torsion:<\/span><\/em><\/h3>\n

Loss or reduction of color Doppler flow\/Spectral Doppler tracings to affected testicle (Must compare to other testicle)<\/p>\n

\"\"<\/pre>\n
Affected testicle becomes more heterogeneous than other testicle<\/p>\n
\"\"Adhikari,\u00a0S.\u00a0R. (2008). Small parts - Testicular ultrasound. Retrieved from <\/em>https:\/\/www.acep.org\/sonoguide\/smparts_testicular.html<\/em><\/a><\/pre>\n
Thickened, hypoechoic mediastinum5\u00a0<\/sup><\/sup><\/p>\n
\"\"<\/sup><\/sup>Prando D. Torsion of the spermatic cord: the main gray-scale and doppler sonographic signs.<\/a> Abdom Imaging. 2009 Sep-Oct;34(5):648-61. doi: 10.1007\/s00261-008-9449-8. Review. PubMed PMID: 18709404.\u00a0<\/span><\/pre>\n
Whirlpool sign6<\/sup><\/p>\n
\"\"<\/pre>\n<\/div><\/div>\n<\/div>\n<\/div>\n<\/div>\n
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Author<\/h3>
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Marissa Wolfe, MS4; Amir Aminlari, MD, Emergency Ultrasound Fellowship Director at UCSD<\/p>\n<\/div><\/div>\n
References<\/h3>
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    \n
  1. Mellick LB, Sinex JE, Gibson RW, Mears K.\u00a0A Systematic Review of Testicle Survival Time After a Torsion Event.<\/a>\u00a0Pediatr Emerg Care. 2017 Sep 25. doi: 10.1097\/PEC.0000000000001287. [Epub ahead of print] PubMed PMID: 28953100.<\/li>\n
  2. Sharp VJ, Kieran K, Arlen AM.\u00a0Testicular torsion: diagnosis, evaluation, and management.<\/a>\u00a0Am Fam Physician. 2013 Dec 15;88(12):835-40. Review. PubMed PMID: 24364548.<\/li>\n
  3. Wang S, Scoutt L.\u00a0Testicular torsion and manual detorsion.<\/a>\u00a0Ultrasound Q. 2013 Sep;29(3):261-2. doi: 10.1097\/RUQ.0b013e3182a2d129. PubMed PMID: 23945494.<\/li>\n
  4. Adhikari,\u00a0S.\u00a0R. (2008). Small parts - Testicular ultrasound. Retrieved from https:\/\/www.acep.org\/sonoguide\/smparts_testicular.html<\/li>\n
  5. Prando D. Torsion of the spermatic cord: the main gray-scale and doppler sonographic signs.<\/a> Abdom Imaging. 2009 Sep-Oct;34(5):648-61. doi: 10.1007\/s00261-008-9449-8. Review. PubMed PMID: 18709404.<\/li>\n
  6. Kalfa N, Veyrac C, Lopez M, Lopez C, Maurel A, Kaselas C, Sibai S, Arena F, Vaos G, Br\u00e9aud J, Merrot T, Kalfa D, Khochman I, Mironescu A, Minaev S, Av\u00e9rous M, Galifer RB.\u00a0Multicenter assessment of ultrasound of the spermatic cord in children with acute scrotum.<\/a>\u00a0J Urol. 2007 Jan;177(1):297-301; discussion 301. PubMed PMID: 17162068.<\/li>\n
  7. Vijayaraghavan SB.\u00a0Sonographic differential diagnosis of acute scrotum: real-time whirlpool sign, a key sign of torsion.<\/a>\u00a0J Ultrasound Med. 2006 May;25(5):563-74. PubMed PMID: 16632779.<\/li>\n<\/ol>\n<\/div><\/div>\n<\/div>\n<\/div>\n<\/div>\n","protected":false},"excerpt":{"rendered":"A 13-year-old male presents to the emergency department with right testicular pain for one-hour duration. The pain began while having a bowel movement. He had no nausea or vomiting. His exam is notable for a high riding right testicle and tenderness to palpation over the right testicle. Vitals: T: 97.8, HR: 106, BP: 135\/79, RR: … 
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