Sonographic diagnosis of acute spermatic cord torsion. Rotation of the cord: a key to the diagnosis.
BACKGROUND
Although the primary abnormality in testicular torsion is at the spermatic cord, imaging studies up to now have mostly been oriented to evaluation of the testicle itself, with emphasis on color Doppler ultrasonography (US). However, findings can be inaccurate when there is incomplete interruption of testicular flow. Indirect findings, such as morphological changes in the testis alone, are not reliable for the diagnosis since they become evident late in the disease.


OBJECTIVE
To call to attention to the fact that sonographic visualization of the spermatic cord can be the key for diagnosis in those patients with acute scrotal pain as a result of testicular torsion, particularly when color Doppler US shows that intratesticular flow is present within the affected testis.


METHODS
Six patients who presented clinically with acute scrotal pain and had spermatic cord torsion, proven at surgery. All patients were initially studied with color Doppler US, and intratesticular flow was detected in all of them. Patients who showed structural abnormalities on gray-scale US and/or absence of intratesticular vascular flow in the affected testis were not included. In addition to a conventional study, the spermatic cord was examined.


RESULTS
The spermatic cord was shown to be rotated on the symptomatic side in all patients. Local morphological and vascular flow changes, distal and at the site of the torsion, were found and registered.


CONCLUSIONS
The finding of a rotated spermatic cord could be a highly reliable and direct sign for the diagnosis of a testicular torsion, and this is especially important when vascular flow is present within the affected testis on color Doppler US examination. Examination of the spermatic cord should be added to evaluation of the testis in patients with suspected testicular torsion to enhance sensitivity of the examination.
Arce
José D
JD
Department of Radiology, Clínica Santa María, Av. Santa María 0410, Santiago, Chile. jarce@csm.cl
Cortés
Marcela
M
Vargas
Juan C
JC
D000208:Acute Disease; D000293:Adolescent; D000328:Adult; D002648:Child; D006801:Humans; D008297:Male; D017699:Pelvic Pain; D012399:Rotation; D013085:Spermatic Cord / Q000033:anatomy & histology / Q000473:pathology; D013086:Spermatic Cord Torsion / Q000175:diagnosis* / Q000473:pathology; D014102:Torsion Abnormality; D018615:Ultrasonography, Doppler, Color / Q000379:methods*