Sonographic differential diagnosis of acute scrotum: real-time whirlpool sign, a key sign of torsion

Journal of Ultrasound in Medicine : Official Journal of the American Institute of Ultrasound in Medicine
S Boopathy Vijayaraghavan

Abstract

The purpose of this study was to prospectively investigate the role of high-resolution and color Doppler sonography in the differential diagnosis of acute scrotum and testicular torsion in particular. Patients who underwent sonography for acute scrotum between April 2000 and September 2005 were included in the study. Gray scale and color Doppler sonography of the scrotum was performed. The spermatic cord was studied on longitudinal and transverse scans from the inguinal region up to the testis, and the whirlpool sign was looked for. During this period, 221 patients underwent sonography for acute scrotum. Sixty-five had epididymo-orchitis with a straight spermatic cord, a swollen epididymis, testis, or both, an absent focal lesion in the testis, and increased flow on color Doppler studies along with the clinical features of infection. Three had testicular abscesses. Sonography revealed features of torsion of testicular appendages in 23 patients and acute idiopathic scrotal edema in 19. Complete torsion was seen in 61 patients who had the whirlpool sign on gray scale imaging and absent flow distal to the whirlpool. There was incomplete torsion in 4 patients in whom the whirlpool sign was seen on both gray scale and color Doppler ...Continue Reading

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