page_title: Scrotal ultrasound
section_title: Testicular torsion
hierarchical_section_title: Scrotal ultrasound / Other benign lesions of the scrotum / Testicular torsion
caption_attribution_description: English: Scrotal ultrasonography of a testicular torsion.
context_page_description: Scrotal ultrasound is a medical ultrasound examination of the scrotum. It is used in the evaluation of testicular pain, and can help identify solid masses.
context_section_description: The normal testis and epididymis are anchored to the scrotal wall. If there is a lack of
  development of these attachments, the testis is free to twist on its vascular pedicle. This will
  result in torsion of the spermatic cord and interruption of testicular blood flow. Testicular
  torsion occurs most commonly at 12 to 18 years but can occur at any age. Torsion results in
  swelling and edema of the testis, and as the edema increases, testicular perfusion is further
  altered. The extent of testicular ischemia depends on the degree of torsion, which ranges
  from 180° to 720° or greater. The testicular salvage rate depends on the degree of torsion and
  the duration of ischemia. A nearly 100% salvage rate exists within the first 6 hours after the
  onset of symptoms; a 70% rate, within 6–12 hours; and a 20% rate, within 12–24 hours. Therefore, testicular torsion is a surgical emergency and the role of ultrasound is to differentiate it from epididymitis as both disease
  presents with acute testicular pain clinically.
  There are two types of testicular torsion: extravaginal and intravaginal. Extravaginal torsion
  occurs exclusively in newborns. Ultrasound findings include an enlarged heterogeneous
  testis, ipsilateral hydrocele, thickened scrotal wall and absence of vascular flow in the testis
  and spermatic cord. The ultrasound findings of intravaginal torsion vary with the duration and the degree of rotation of the spermatic cord. Gray scale ultrasound may appear normal if the torsion is just occurred. At 4–6 hours
  after onset of torsion, enlarged testis with decreased echogenicity is seen. At 24 hours after
  onset, the testis appears heterogeneous due to vascular congestion, hemorrhage and
  infarction. As gray scale ultrasound is often normal during early onset of
  torsion, Doppler sonography is considered as essential in early diagnosis of testicular
  torsion. The absence of testicular flow at color and power Doppler ultrasound is considered
  diagnostic of ischemia, provided that the scanner is set for detection of slow flow,
  the sampling box is small and the scanner is adjusted for the lowest repetition frequency
  and the lowest possible threshold setting.
caption: Fig. 26. Testicular torsion of the right testis. Absence of vascular flow and ill-defined hypoechoic lesions are seen in the testis.[citation needed]
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