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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