The real-time whirlpool sign is the most specific sign of partial or complete testicular torsion. He had no nausea or vomiting. Testicular sonography has contributed greatly to the preoperative diagnosis of testicular torsion in the pediatric patient and is the mainstay for evaluation of acute scrotal pain. Imaging Assessment. J Ultrasound Med. This is true regardless of colour Doppler US findings [2, 3]. PURPOSE: A positive whirlpool sign (WS) is defined as the presence of a spiral-like pattern when the spermatic cord is assessed during ultrasonography (US), using standard, high-resolution ultrasonography (HRUS) and/or color Doppler sonography (CDS), in the presence of testicular torsion. Bookmarks (0) Ultrasound. Testicular ultrasound was carried out in both cases, during an acute episode of pain. Testicular torsion occurs when a testicle torts on the spermatic cord resulting in the cutting off of blood supply. • A reactive hydrocele and scrotal skin thickening are often seen with torsion. Introduction: Emergency department physicians should incorporate point-of-care-ultrasound (POCUS) in the assessment of patients presenting with acute scrotal pain for rapid identification of the time sensitive urologic emergency, testicular torsion. A positive whirlpool sign (WS) is defined as the presence of a spiral-like pattern when the spermatic cord is assessed during ultrasonography (US), using standard, high-resolution ultrasonography (HRUS) and/or color Doppler sonography (CDS), in the presence of testicular torsion. The whirlpool sign is a characteristic sonographic finding indicative of testicular torsion. Intermittent testicular torsion is a challenging clinical condition with a spectrum of clinical and sonographic features. Diagnosis and management of testicular torsion in the Emergency Department. Acute epididymitis is commonly the cause of acute scrotal pain in adults and should be differentiated from testicular torsion. The sonographic real-time whirlpool sign is the most specific and sensitive sign of torsion, both complete and incomplete. Testicular torsion is the sudden twisting of the spermatic cord within the scrotum.It most commonly affects neonates and young men. Hod N, Maizlin Z, Strauss S, et al. testicular torsion. Although pseudomass and whirlpool sign have been reported in patients with complete, partial, and intermittent testicular torsion [11, 13, 14], intermittent testicular torsion is unique because it can have spontaneous resolution of symptoms and may show a return of blood flow to a previously avascular testicle during ultrasound evaluation. The whirlpool sign is the most definitive sign of TT, as it has 100% specificity and sensibility [2]. SOAP NOTE ON TESTICULAR TORSION 2 Soap Note on Testicular Torsion Name: Date: Time: Age: 18 Sex: Female SUBJECTIVE CC “I have severe pain and swelling of the scrotum and abdominal pain.” HPI: A Hispanic man aged 18 years old came to the office complaining of severe pain in his scrotum. Identification of a sonographic “whirlpool sign” related to twisting of the spermatic cord is reported to be and Sonography Doppler. 7 An ultrasound that reveals a “whirlpool sign” is significant in diagnosing testicular torsion. PurposeA positive whirlpool sign (WS) is defined as the presence of a spiral-like pattern when the spermatic cord is assessed during ultrasonography (US), using standard, high-resolution ultrasonography (HRUS) and/or color Doppler sonography (CDS), in the presence of testicular torsion. Gray-scale and Doppler ultrasound findings are key to the diagnosis. At admission, testicular torsion was the apparent diagnosis owing to the redness, stiffness, pain, and elevation of the testes. The relative merits of Doppler sonography in the evaluation of patients with clinically and scintigraphically suspected testicular torsion. It is crucial to note that the Doppler ultrasound is the key diagnostic tool in identifying a testicular torsion. CONCLUSIONS: Sonography of acute scrotum should include study of the spermatic cord. Although exceedingly rare, there are case reports of testicular torsion occurring in men over the age of 40. 6.39a, b). In patients with acute torsion, the epididymis may appear hypoechoic and enlarged, similar to epididymitis. The typical patient is a teenage boy, but it can occur at any age. Summary. Despite its high sensitivity and specificity, both false-negative and false-positive findings occur. been described as a snail-shell, a whirlpool, a doughnut or a storm on a weather map. Scrotum. The whirlpool sign is an important diagnostic marker in the evaluation of suspected testicular torsion by point- of-care ultrasound. The diagnosis of testicular torsion can be made clinically. Sonographic differential diagnosis of acute scrotum: real-time whirlpool sign, a key sign of torsion. Vijayaraghavan SB. Case Report. Case Report: A 20-year-old otherwise healthy male, with a history of monorchism, presented to the emergency department with vague testicular pain. There was no Doppler flow to the right testicle. Terminology. ... real-time whirlpool sign, a key sign of torsion. <360°).It is considered to be the most specific and sensitive sign for testicular torsion. Despite its high sensitivity and specificity, both false-negative and false-positive findings occur. Evaluate the acute scrotum with ultrasound, helping you diagnose various scrotal pathologies. This review discusses the clinical and sonographic findings of intravaginal and extravaginal testicular torsion, including the normal sonographic and vascular anatomy of the testis. The role of ultrasound imaging in adult patients with testicular torsion: a systematic review and meta-analysis. Because of the risk of ischemia and possible infarction of the testis, it is considered a urological emergency.Testicular torsion is characterized by sudden-onset unilateral testicular pain, which may radiate to the lower abdomen, with nausea and … This is the most sensitive and specific sign for torsion, even more so than absence of intratesticular flow on colour Doppler.1,2 Testicular torsion occurs in approximately 1 in every 4000 men under the age of 25 years. Sonographic differential diagnosis of acute scrotum: real-time whirlpool sign, a key sign of torsion. Figure 16.5B Sagittal Doppler ultrasound of right testicle revealed no detectable blood flow in the testicle. The whirlpool sign is a spiral twist of the spermatic cord caused by testicular torsion. His exam is notable for a high riding right testicle and tenderness to palpation over the right testicle. Testicular torsion is one of the common causes of acute scrotal pain. However, it can result in vascular compromise, leading to testicular ischemia and injury and, if not corrected, necrosis and testicular loss. Testicular torsion is traditionally diagnosed with ultrasound which will reveal an enlarged testicle, increased echogenicity, and decreased Doppler flow compared to the contralateral testicle. Although ultrasound with color Doppler is the most commonly used imaging modality, torsion of undescended non neoplastic testis in an adult may be identified using non contrast computed tomography (CT) using the “Inguinoscrotal whirlpool sign on CT.”. Findings: The right testicle was uniform in appearance. Testicular torsion refers to twisting of the spermatic cord with rotation of the testicle. These ultrasound images demonstrates limited flow into the right testicle suggestive of testicular torsion. Test. The most common symptom is acute testicular pain and the most common underlying cause, a bell-clapper deformity.The diagnosis is often made clinically but if it is in doubt, an ultrasound is helpful in confirming the diagnosis. Vijayaraghavan SB. What is the major impact of the image(s)? A 13-year-old male presents to the emergency department with right testicular pain for one-hour duration. The “whirlpool sign” in the spermatic cord is an important indicator suggestive of testicular torsion. A definitive sign, as observed in this case, is twisting of the spermatic cord, also called the “whirlpool sign.” 7 The whirlpool sign is a reliable and direct sonographic finding that implies torsion of the spermatic cord and testis. Torsion is a known complication of cryptorchid testis. There are no studies in the literature on the use of MRI in the diagnosis of incomplete testicular torsion that A,B.6 years 4 month-old boy with rst episode of acute left scrotal pain for 2 days. The term whirlpool sign is used in other contexts: see whirlpool sign (disambiguation).. Radiographic features The whirlpool sign of the spermatic cord is a direct sign of testicular torsion, both complete and incomplete (i.e. Manual detorsion was performed at the bedside using the “open-the-book” maneuver with subsequent ultrasound demonstrating return of flow to the right testicle. demonstration of torsion knot and whirlpool patterns on non-contrast MRI, resulting from twisting of the sper-matic cord, yielded 100% accuracy in the diagnosis of incomplete testicular torsion in patients with subacute scrotal pain. Test. Testicular torsion is rare in patients older than age 35. link. Presence of docume … He says that he woke up with severe pain in his scrotum and he also noted swelling in scrotum. Developed by renowned radiologists in each specialty, STATdx provides comprehensive decision support you can rely on - Testicular Torsion The whirlpool sign is a spiral twist of the spermatic cord caused by testicular torsion. A ‘whirlpool’ appearance to the spermatic cord was visualized. Developed by renowned radiologists in each specialty, STATdx provides comprehensive decision support you can rely on - Testicular Torsion/Infarction. A sonographic finding that is definitive for testicular torsion is the “whirlpool sign,” in which there is an abrupt change in the course of the spermatic cord with a spiral twist at the external inguinal ring or in the scrotal sac. Testicular sonography has contributed greatly to the preoperative diagnosis of testicular torsion in the pediatric patient and is the mainstay for evaluation of acute scrotal pain. 231 EO. Ultrasound showed no whirlpool sign, and the absence of a blood flow echoic lesion in the parenchymal testes supported the presence of necrotic testes . Vijayaraghavan SB. Testicular torsion can occur at any age, but it is primarily associated with a bimodal distribution in the first year of life and in adolescence. Torsion knot and whirlpool patterns result from the twisting of the spermatic cord, which produces distortion of cord structures. Testicular torsion can occur at any age. The real-time whirlpool sign is the most specific sign of partial or complete testicular torsion. Answer. Ota K, Fukui K, Oba K, Shimoda A, Oka M, Ota K, Sakaue M, Takasu A J Med Ultrason (2001) 2019 Jul;46(3):325-334. With testicular torsion ultrasound may also demonstrate that the spermatic cord immediately cranial to the testis and epididymis is twisted, which gives it a characteristic ‘torsion knot’ or ‘whirlpool appearance ’ (Fig. 14. • The spermatic cord immediately cranial to the testis and epididymis is twisted, causing a characteristic torsion knot or “whirlpool pattern” of concentric layers ULTRASOUND FOR TESTICULAR TORSION 18. •Sonographic findings of testicular torsion on Doppler ultrasound: •Decreased/absent testicular perfusion •Twisting of the spermatic cord (“whirlpool sign” –most specific finding) •Increased testicular and epididymal size •Heterogeneous echotexture (late … We therefore performed emergency surgery. Sonographic differential diagnosis of acute scrotum: real-time whirlpool sign, a key sign of torsion. Torsion of the sper- The pain began while having a bowel movement. Although intratesticular blood flow in the affected testis was present in some cases of testicular torsion, the whirlpool sign was often positive. Neonatal testicular torsion, defined as torsion occurring within the first 30 days of life, is a rare occurrence. Vijayaraghavan SB. The real-time whirlpool sign (the swirling appearance of the spermatic cord from torsion as the ultrasound probe scans downward perpendicular to the spermatic cord) is a specific sign of partial or complete testicular torsion. Although intratesticular blood flow in the affected testis was present in some cases of testicular torsion, the whirlpool sign was often positive. 2006 May;25(5):563-74. Purpose: A positive whirlpool sign (WS) is defined as the presence of a spiral-like pattern when the spermatic cord is assessed during ultrasonography (US), using standard, high-resolution ultrasonography (HRUS) and/or color Doppler sonography (CDS), in the presence of testicular torsion. In incomplete torsion, the whirlpool sign is seen in B-mode and colour Doppler US and there is flow in the vessels of the whirlpool sign, distal to it and intra-testicular [2]. Less common diagnoses include strangulated hernia, segmental testicular infarction, trauma, testicular tumor, and idiopathic scrotal edema. However, imaging plays an important role, especially when it comes to differentiating torsion, which is a surgical emergency, from epididymo-orchitis [3]. Diagnosis. It is a urological emergency, and a delay in treatment increases the risk of ischaemia and necrosis of the testicle, leading to sub-fertility or infertility.. In cases of suspected testicular torsion, if there is a present
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