It is well known that the absence of testicular vascularity is a direct sign of ischemia which should be managed with emergency surgery. But not everyone is aware that the presence of color-Doppler signal does not exclude ischemia and therefore testicular torsion because this should be considered as a dynamic phenomenon and ultrasound patterns can moreover vary according to the moment (high degree torsion, low degree torsion, detorsion). The manuscript summarizes the direct and indirect ultrasound features that enable a correct diagnosis of testicular torsion in most cases, thus reducing the diagnostic error. Through their recommendations, the authors also explain, step by step, how a testicular ultrasound examination should be performed (from the objective examination and medical history to the evaluation of intratesticular vascular flows), listing the findings needing further investigation and any differential diagnoses; these recommendations are based both on literature and on the expertise of the authors and are useful not only for their clinical importance but also for their medico-legal implications. Although surgical intervention is usually avoided whenever not strictly necessary, nowadays exploratory surgery is used far too often to exclude testicular torsion following an incomplete or not decisive ultrasound investigation.
The manuscript has therefore a dual purpose, i.e. to increase the ultrasound diagnostic confidence by emphasizing how the presence\absence of vascularization cannot be the only diagnostic element in a clinical suspicion of testicular torsion but also to provide a guide to the way a scrotal ultrasound examination should be performed without neglecting any detail.
Written by: Irene Campo1 & Nicola Pavan2
- Radiology Unit, Department of Medical, Surgical and Health Sciences, University of Trieste, Trieste, Italy.
- Department of Surgical, Oncological, and Oral Sciences, University of Palermo, Palermo, Italy.