title: Sonography of intrascrotal appendage torsion: varying echogenicity of the torsed appendage according to the time from onset.
abstract: OBJECTIVE
  The purpose of this study was to evaluate sonographic findings in torsed intrascrotal appendages and to assess the effect of the time from symptom onset on echogenicity and the relationship between the time from symptom onset and manual reduction success.
  
  
  METHODS
  Thirty-five boys (6-13 years old; mean, 9.9 years) with torsion of an intrascrotal appendage were evaluated. All had painful unilateral scrotal swelling and palpable tender nodules on physical examination and underwent sonography. Thirty-two underwent subsequent manual reduction. Before manual reduction, we assessed the size, echogenicity, appendage blood flow, periappendiceal blood flow, and scrotal swelling. Data were analyzed according to time from symptom onset. After manual reduction, the number of reduction trials, pain relief, size, and blood flow of the appendix testis were assessed.
  
  
  RESULTS
  The torsed appendage was hypoechoic in all 17 boys assessed within 24 hours of symptom onset. In boys assessed more than 24 hours after onset, the torsed appendage was hypoechoic in 6, isoechoic in 4, and hyperechoic in 8. Twenty-two of 23 hypoechoic appendages showed a salt-and-pepper pattern. The echogenicity differed significantly between boys assessed within and more than 24 hours after symptom onset (P < .001). The success rates of manual reduction were 90.9% (20 of 22) for hypoechoic appendages, 75.0% (3 of 4) for isoechoic appendages, and 50.0% (3 of 6) for hyperechoic appendages. Sonography revealed increased blood flow and decreased appendage sizes in all boys with successful reduction.
  
  
  CONCLUSIONS
  The echogenicity of a torsed appendage changes according to the time from onset. A hyperechoic intrascrotal appendage is associated with later sonography and is a poor predictor of manual reduction success.
authors.affiliation: Department of Diagnostic Radiology, Kyung Hee University Hospital, 1 Hoegi-dong, Dongdaemun-gu, Seoul 130-701, Korea. indawn@hanafos.com
authors.forename: Seong Jin
authors.initials: SJ
authors.lastname: Park
authors.forename: Hye Lin
authors.initials: HL
authors.lastname: Kim
authors.forename: Boem Ha
authors.initials: BH
authors.lastname: Yi
mesh_terms: D000293:Adolescent; D016009:Chi-Square Distribution; D002648:Child; D003937:Diagnosis, Differential; D006801:Humans; D008297:Male; D010147:Pain Measurement; D012611:Scrotum / Q000098:blood supply / Q000000981:diagnostic imaging*; D013086:Spermatic Cord Torsion / Q000000981:diagnostic imaging* / Q000628:therapy*; D016896:Treatment Outcome; D018608:Ultrasonography, Doppler / Q000379:methods*