Case 112: Testicular Early Subacute Torsion & Diffuse Microlithiasis || Ultrasound

            

Clinical Features:

A 13-year-old male patient came with

- Severe left hemiscrotal pain for around 4 days

- Scrotal swelling

Ultrasound Features:

- Swollen left testis & epididymis with inhomogeneous parenchymal echotexture. 

- Multiple irregular anechoic spaces within the left testicular parenchyma.

- Color Doppler shows no detectable flow within the left testis & epididymis.

- A lamellated mass with concentric layering just cephalad to the left testis representing the coiled spermatic cord components forming the ‘whirlpool sign’ with twisting or whirling on color Doppler.

- Discrete punctate non-shadowing hyperechoic foci diffusely scattered throughout the testicular parenchyma bilaterally with comet tail artifacts.

- Left sided mild hydrocele with internal non-vascular septations.

- Thickening of the left hemiscrotal skin.

Remember:

- In case of incomplete testicular torsion, color Doppler may show vascularity within the testis.

- An increase in arterial RI of >0.75 & absence of intratesticular venous flow may help confirm testicular torsion.

- Clusters of testicular microliths may represent testicular tumor without soft tissue mass.

- Clusters of microliths adjacent to solid mass suggest a germ cell tumor.

Ultrasound Diagnosis:

- Left testicular early subacute torsion with mild reactionary hydrocele.

- Bilateral diffuse testicular microlithiasis.

Ultrasound Images:

Right testicular diffuse microlithiasis

Swollen left testis & epididymis with inhomogeneous parenchymal echotexture. 

Multiple irregular anechoic spaces within the left testicular parenchyma.

Left testicular diffuse microlithiasis.

Color Doppler shows no detectable flow within the left testis & epididymis.

Left sided mild hydrocele with internal non-vascular septations.

A lamellated mass with concentric layering just cephalad to the left testis representing the coiled spermatic cord components forming the ‘whirlpool sign’ with twisting or whirling on color Doppler.

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