Spermatic cord torsion with preserved testis perfusion: initial anatomical observations.
OBJECTIVE
Despite the high sensitivity and specificity of scrotal ultrasonography, there continue to be reports of missed torsion. These "false-negative" scans are attributed to technical factors and intermittent torsions. We hypothesize that patients with specific anatomical configurations maintain testicular blood flow for prolonged periods, and, therefore, will have flow on ultrasound despite concurrent torsion.


METHODS
Patient charts and scrotal ultrasounds were reviewed to identify patients younger than 18 years who underwent scrotal exploration between January 1998 and January 2003 for acute scrotum. Patients who underwent radiological evaluation before scrotal exploration were the main focus of this study. Operative reports were reviewed for specific anatomical details.


RESULTS
A total of 61 patients underwent scrotal exploration for acute scrotum during the study period. Of these patients 14 had torsion confirmed intraoperatively and a preoperative scrotal ultrasound available. Four of these 14 patients had normal testicular blood flow on ultrasound but had testicular torsion confirmed intraoperatively. Operative findings suggest that these patients have specific anatomical characteristics.


CONCLUSIONS
Testis perfusion can be maintained for a prolonged period in the presence of testicular torsion. Anatomical variability may account for differences in the duration of viability of the torsed testis. A high index of suspicion must be maintained to avoid missing the diagnosis of testicular torsion in these challenging cases.
Bentley
Dennis F
DF
Department of Urology, Northeastern Ohio Universities College of Medicine, Akron, Ohio, USA.
Ricchiuti
Daniel J
DJ
Nasrallah
Phillip F
PF
McMahon
Daniel R
DR
D000293:Adolescent; D002648:Child; D006801:Humans; D008297:Male; D012039:Regional Blood Flow; D012189:Retrospective Studies; D013085:Spermatic Cord / Q000033:anatomy & histology / Q000000981:diagnostic imaging; D013086:Spermatic Cord Torsion / Q000000981:diagnostic imaging*; D013737:Testis / Q000098:blood supply*; D018608:Ultrasonography, Doppler