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Testicular Early Subacute Torsion & Diffuse Microlithiasis || Ultrasound || Case 323

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Clinical Features:
A 13-year-old male patient came with
Severe left hemiscrotal pain for around 4 days
Scrotal swelling

Ultrasound Features:
Swollen left testis & epididymis with inhomogeneous parenchymal echotexture.
Multiple irregular anechoic spaces within the left testicular parenchyma.
Color Doppler shows no detectable flow within the left testis & epididymis.
A lamellated mass with concentric layering just cephalad to the left testis representing the coiled spermatic cord components forming the ‘whirlpool sign’ with twisting or whirling on color Doppler.
Discrete punctate non-shadowing hyperechoic foci diffusely scattered throughout the testicular parenchyma bilaterally with comet tail artifacts.
Left sided mild hydrocele with internal non-vascular septations.
Thickening of the left hemiscrotal skin.

Remember:
In case of incomplete testicular torsion, color Doppler may show vascularity within the testis.
An increase in arterial RI of more than 0.75 & absence of intratesticular venous flow may help confirm testicular torsion.
Clusters of testicular microliths may represent testicular tumor without soft tissue mass.
Clusters of microliths adjacent to solid mass suggest a germ cell tumor.

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