Indian Journal of Radiology and Imaging Indian Journal of Radiology and Imaging

: 2002  |  Volume : 12  |  Issue : 3  |  Page : 363--364

Imaging signs : Gray scale sonographic markers in intravaginal tarsion testis

S Ganesan, G Karthik 
 Dept of Radiology and Imaging GKNM Hospital, Coimbatare 641037, India

Correspondence Address:
S Ganesan
Dept of Radiology and Imaging GKNM Hospital, Coimbatare 641037

How to cite this article:
Ganesan S, Karthik G. Imaging signs : Gray scale sonographic markers in intravaginal tarsion testis.Indian J Radiol Imaging 2002;12:363-364

How to cite this URL:
Ganesan S, Karthik G. Imaging signs : Gray scale sonographic markers in intravaginal tarsion testis. Indian J Radiol Imaging [serial online] 2002 [cited 2020 Sep 22 ];12:363-364
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Full Text

Torsion testis, a misnomer referring to twisting of the spermatic cord is a surgical emergency, since it results in compromise of vascular supply to the extremely sensitive gonadal tissue. Morphologically and functionally the fate of the testis subjected to this ischemic insult largely depends upon the time factor elapsed between the time of onset and surgical efforts to restore its vascular supply.[1] The degree of torsion varies between 180-720 degrees in different cases. Even with less than 360 degrees torsion, a vicious cycle gets established by the progressively increasing testicular congestion and edema, which in turn acts as a facilitator promoting further torsion. Torsion testis is basically of two types; Extravaginal torsion, presenting in neonatal period and intravaginal torsion occurring in older children within the tunica vaginalis. Intravaginal torsion is related to an anomalous testicular suspension, which tends to be bilateral in many instances, approaching as high as 40% in certain series. [2]

Color Doppler sonography (CDS) along with power Doppler studies have become the procedure of choice in evaluating testicular perfusion. Diagnosis is straightforward in cases with absence of blood flow on the symptomatic side and demonstration of normal flow signals in the contralateral normal testis. CDS findings may be inconclusive in certain clinical settings. Intratesticular flow may be present inspite of twisted cord leading to an erroneous diagnosis. In young children sometimes it may not be possible to demonstrate color flow signals bilaterally[3]

The entire spermatic cord from the level of the external ring upto the level of the testis can be imaged easily with high resolution ultrasound. By meticulous scanning it is possible to demonstrate directly the "spiral twist" in the cord sonologically as an abrupt reduction in the size of the cord at the point of twist. The spermatic cord proximal to the twist may show an increase in diameter, shape and course due to the accompanying venous congestion. 3 These sequence of events result in the classic imaging appearances of "figure of eight" or "wringing of the cord" or "twisted cord" pattern at the point of spiral twist in a case of torsion testis. [Figure 1]a and b

The direct demonstration of the point of spiral twist in the cord is a pathognomonic sign of torsion, the only exception being torsion followed by spontaneous detorsion. Reactive hydrocele is often present in cases of torsion testis. The extent of this reactive hydrocele, serves as an indirect additional sonographic marker for torsion. The hydrocele typically extends high up more distally towards the cord in view of the high atypical insertion of the tunica vaginalis caused by the "bell-clapper' anomaly of testicular suspension within the vaginal sac.[4] Reactive hydrocele, when present also helps in easy visualization of the point of spiral twist as it is surrounded by the fluid all around.

The presence of a spiral twist is an absolute sign of torsion, irrespective of the perfusion status of the testis. The characteristic extent of reactive hydrocele when present serves as an additional valuable sign. These gray scale sonographic markers must be diligently looked for in all clinically suspected cases of testicular torsion.


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