SCROTAL ULTRASOUND FOR EVALUATION OF SUBACUTE TESTICULAR TORSION - SONOGRAPHIC FINDINGS AND ADVERSE CLINICAL IMPLICATIONS

There is an increased use of scrotal ultrasound in the clinician's off ice and emergency room for the investigation of scrotal pain. The use of real-time scrotal ultrasound for the diagnosis of testicular torsio n has been described in the literature. A false-negative ultrasound ex amination can postpone the diagnosis of torsion and result in testicul ar loss. We examined 6 patients 1 day to 18 years old who had subacute testicular torsion with scrotal symptomatology (pain and/or swelling) for longer than 8 hours (range 12 hours to 6 days). Scrotal ultrasoun d was performed as 1 of the initial tests. A common sonographic patter n was an inhomogeneous testicle with hypoechoic areas alternating with hyperechoic areas and thickening of adjacent scrotal tissue. Another common finding was an edematous hyperechoic epididymis and a small hyd rocele. In 4 of the 6 cases these nonspecific findings suggested a mis leading diagnosis of tumor or epididymitis and resulted in delay of su rgery and testicular loss. Treatment was not delayed in only 2 patient s in whom the diagnosis of torsion was made initially by history and p hysical examination, and ultrasound was done for interest only. Misdia gnosis of intratesticular blood flow and some potential pitfalls of sc rotal imaging by color Doppler ultrasound are discussed. We conclude t hat real-time scrotal sonography can be misleading in cases of subacut e testicular torsion and, therefore, it should not be used in this cli nical setting.