Testicular torsion?

Acute scrotal pain; salvage declines sharply with time but remains possible after 24 hours — a positive call is a phone call, regardless of symptom duration.

Answer the surgeon

Immediate scrotal exploration — urology operates on this study.

Your answer must state:

Intratesticular flow: color AND spectral, compared side-to-side with identical settings
Spermatic-cord whirlpool sign
Testis size and echotexture — heterogeneity suggests later ischemic injury but does not determine viability by itself
Abnormal lie: transverse, high-riding
Reactive hydrocele and scrotal wall edema

Key and direct findings

1.Absent or clearly asymmetric intratesticular flow
Interrogate arteries and veins with color and spectral Doppler; compare with the asymptomatic side using identical gain, PRF, and depth.
Pitfall: Preserved arterial flow does NOT exclude partial or early torsion — venous compromise may precede loss of arterial flow, so interrogate the veins.
2.Spermatic-cord whirlpool
A twisted, swirling cord above the testis is the direct sign of torsion and works even when flow is preserved.

Supportive signs & checks

1.Size and echotexture
An enlarged hypoechoic testis is early ischemia; heterogeneous echotexture means late torsion and threatened viability — say which.
2.Abnormal lie
Transverse orientation or a high-riding testis supports torsion; a reactive hydrocele and wall edema often accompany it.
3.Torsion–detorsion
A spontaneously detorsed testis shows paradoxical hyperemia that mimics orchitis — the history of severe pain that suddenly eased is the clue.
Pitfall: Epididymo-orchitis shows increased flow, but hyperemia after a classic torsion story is detorsion until proven otherwise.
4.A normal study does not overrule the clinic
With a strong clinical picture, a normal US should not talk anyone out of exploration — write that in the report.

Wet-read snippets

Fill the blanks, then copy into your preliminary report.

Positive

Findings of testicular torsion: absent flow in the ___ testis with spermatic-cord whirlpool; testis ___ (homogeneous — potentially viable / heterogeneous — late). Urology notified at ___.

Negative

Symmetric intratesticular arterial and venous flow, no cord twist, normal echotexture — no US evidence of torsion at this time.

Equivocal

Asymmetric but present flow in the ___ testis — partial or intermittent torsion is not excluded; recommend urgent urology assessment.

Sources

Sonographic differential diagnosis of acute scrotum: real-time whirlpool sign — Vijayaraghavan SB. J Ultrasound Med (2006)
Testicular torsion with preserved flow: key sonographic features — Bandarkar AN, Blask AR. Pediatr Radiol (2018)
A systematic review of testicle survival time after a torsion event — Mellick LB et al. Pediatr Emerg Care (2019)

Content review: Content pending clinical review · 2026-07-15

Educational reference for trained clinicians. Verify every result against the cited original guideline before use. Not a substitute for clinical judgment or medical advice.