Torsion more common in boys compared to men.
Two types of torsion - INTRAVAGINAL and EXTRAVAGINAL.
INTRAVAGINAL (more common)
mostly occurs at puberty.
cause - complete investment of testis and epididymis by tunica vaginalis, causing a long stalk of suspension.(\'bell clapper\').
(in more than half the cases, the condition is bilateral)
EXTRAVAGINAL
mostly occurs in newborns.
Not assoc with bell clapper deformity.
Poor attachment of testis to scrotal wall. hence, rotation of testis,epididymis and tunica vaginalis all togather as a single unit.
GRAY SCALE CHANGES
- enlarged.
- echogenecity - initially normal, later heterogenous and hypoechoic.
hypoechogenecity denotes nonviability.
- change in axis of testis.
- \"whirlpook\" pattern of spermatic cord.
- hydrocele.
In untreated cases, the degree of testicular enlargement and hypoechogenicity increases during the first 5days, and then diminishes over next 4-5days.
COLOR DOPPLER
very useful to establish diagnosis and to rule out epididymoorchitis.
In torsion, blood flow is absent/significantly reduced.(blood flow increased in the later)
Surgery performed within 5-6hrs of onset of pain = testicular salvage rate 80-100%
surgery performed after after 12hrs of onset of pain = salvage rate of only 20%.
Hence, the importance of early diagnosis.
Two types of torsion - INTRAVAGINAL and EXTRAVAGINAL.
INTRAVAGINAL (more common)
mostly occurs at puberty.
cause - complete investment of testis and epididymis by tunica vaginalis, causing a long stalk of suspension.(\'bell clapper\').
(in more than half the cases, the condition is bilateral)
EXTRAVAGINAL
mostly occurs in newborns.
Not assoc with bell clapper deformity.
Poor attachment of testis to scrotal wall. hence, rotation of testis,epididymis and tunica vaginalis all togather as a single unit.
GRAY SCALE CHANGES
- enlarged.
- echogenecity - initially normal, later heterogenous and hypoechoic.
hypoechogenecity denotes nonviability.
- change in axis of testis.
- \"whirlpook\" pattern of spermatic cord.
- hydrocele.
In untreated cases, the degree of testicular enlargement and hypoechogenicity increases during the first 5days, and then diminishes over next 4-5days.
COLOR DOPPLER
very useful to establish diagnosis and to rule out epididymoorchitis.
In torsion, blood flow is absent/significantly reduced.(blood flow increased in the later)
Surgery performed within 5-6hrs of onset of pain = testicular salvage rate 80-100%
surgery performed after after 12hrs of onset of pain = salvage rate of only 20%.
Hence, the importance of early diagnosis.