GRAY-SCALE SONOGRAPHY IN TORSION OF THE TESTICULAR APPENDAGES

The reliability of gray-scale ultrasonography in diagnosing torsion of the testicular appendages was studied in a series of 54 boys with acu te non-traumatic scrotal pain. All boys were operated upon, and the ap pendages extirpated irrespective of their appearance at exploration; t he final diagnosis was based on histological examination. Forty-two bo ys had appendicular torsion, 2 had testicular torsion and 10 had other diagnoses. Using the sign of appendicular torsion - an echogenic extr atesticular structure situated between the head of the epididymis and the upper pole of the testis - as the criterion, 37 displayed a true p ositive, 9 a true negative, 3 a false positive and 5 a false negative diagnosis. Thus, the sensitivity was 88 %, the specificity 75 % and th e positive predictive value 93 % respectively. The echogenic mass vari ed in size from 3 to 17 mm in diameter. In 34 of the 42 cases of appen dicular torsion extratesticular fluid was present, and 19 patients sho wed enlargement of the head of the epididymis. It is concluded that gr ay-scale sonography is an accurate and valuable tool in diagnosing tor sion of the testicular appendages.