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Torsion testis final

  1. 1.  Dr Arun Gupta Director imaging  Dr Rakhee gupta Dr R K S Gandhi Dr Vinayak Mittal Dr Ritesh Mahajan TORSION TESTIS
  2. 2. TORSION TESTIS Torsion is more common in boys than in men, and it represents only 20% of the acute scrotal pathologic phenomena in postpubertal males. However, prompt diagnosis is necessary because torsion requires immediate surgery to preserve the testis.  Acute  Sub-Acute  Chronic ------------------  Intra- Vaginal  Extra -Vaginal NORMAL TORSION
  3. 3. The tunica vaginalis does not completely surround the testis and epididymis, which are attached to the posterior scrotal wall . Bell-clapper anomaly. The tunica vaginalis completely surrounds the testis, epididymis,and part of the spermatic cord, predisposing to torsion. Intravaginal torsion. Bell-clapper anomaly with complete torsion of the spermatic cord, compromising the blood supply to the testis. Extravaginal torsion in a neonate. Tunica vaginalis is in normal position, but abnormal motility allows rotation of the testis, epididymis, and spermatic cord.
  4. 4. NORMAL ORIENTATION OF THE RT SIDE TESTIS IS APPRECIATED AND CHANGE IN THE LONG AXIS OF THE LEFT SIDE TESTIS IS SEQUEL TO TORSION ( BELL CLAPPER MORPHOLOGY) . NORMAL TORSION SEQUAEL
  5. 5. COMPARISON BETWEEN NORMAL AND ISCHEMIC TESTIS . NORMAL RT TESTIS HAS MIDLEVEL ECHOES OF THE PARENCHYMA WITH SLOW FLOW VASCULARITY . HYPOECHOIC / HETEROGENOUS ECHOGENECITY OF LEFT TESTIS ( EARLY TORSION). HYPERECHOIC ECOPATTERN CAN BE SEEN WITH INFARCTION / HAEMORRHAGE ALSO NORMAL TESTIS TORSION SEQUAEL NORMAL INTRAPARENCHYMAL VASCULARITY
  6. 6. CORD TESTIS EPIDYDIMIS COMPLEX 1. EPIDYDIMIS may be enlarged and can not be appreciated as separate from the cord leading to formation of CORD / EPIDYDIMIS COMPLEX. 2. EXTRATESTICULAR MASS CAN BE SEQUAEL TO HAEMORRGAE IN EPIDYDIMIS / TUNICA VAGINALIS
  7. 7. Circumferential swirl of the vessels is appreciated proximal to the torison site . Distal to the swirl there is no color fill . TORSION KNOT The spermatic cord immediately proximal to the testis and epididymis is twisted, causing a characteristic torsion knot or “whirlpool pattern” of concentric layers.
  8. 8. HIGH RESISTANCE ARTERIAL FLOW IS APPRECIATED JUST PROXIMAL TO THE TORISON SITE REACTIONARY INCREASE IN THE THICKNESS OF THE SCROTAL SUBCUTIS PLANE WTH INCREASED VASCULARITY OF THE PARATESTICULAR TISSUES ( DARTOS FASCIA )
  9. 9. TORSION TESTIS In torsion,blood flow is absent in the affected testicle or significantly less than in the normal, contralateral testicle. NO BLOOD FLOW IS APPRECIATED IN THE EPIDYDIMIS /TESTIS COMPLEX DISTAL TO SWIRL OF BLOOD FLOW REPRESENTING THE TORSION SITE TORSION KNOT
  10. 10. POST ORCHIDOPEXY IMAGES BOTH TESTIS HAVE NEAR NORMAL COMPARABLE ECHOPATTERN
  11. 11. Potential pitfalls ….while diagnosing torsion PARTIAL TORSION : Torsion of at least 540 degrees is necessary for complete arterial occlusion .With partial torsion of 360 degrees, or less, arterial flow may still occur, but venous outflow is often obstructed causing diminished diastolic arterial flow on spectralDoppler examination. TORSION/DETORSION :If spontaneous detorsion occurs, flow within the affected testis may be normal, or it may be increased and mimic orchitis. Spontaneous detorsion rarely occurs and leaves a segmental testicular infarction. ISCHEMIA FROM ORCHITIS :Segmental testicular infarction may also occur with Henoch-Schönlein purpura or with orchitis . Orchitis may also cause global ischemia of the testis and mimic torsion.
  12. 12. REFERENCE DIAGNOSTIC ULTRASOUND FOURTH EDITION Carol M. Rumack, MD, FACR J. William Charboneau, MD, FACR Deborah Levine, MD, FACR

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