Bilateral Antenatal Testicular Torsion Joseph Junewick, MD FACR 02/09/2010 History 5 day old with firm bilateral scrotal masses. Diagnosis Bilateral Antenatal Testicular Torsion Discussion Neonatal testicular torsion is a unique clinical entity. Most patients present with scrotal swelling and discoloration. Torsion involves all contents of the hemiscrotum and is referred to a extravaginal since the tunica albuginea is only loosely adhered to the scrotal wall (in adolescents and adults, torsion is intravaginal). Traubici et al. describe 3 US appearances of neonatal torsion which likely reflect the natural evolution: Type I-The testicle is markedly enlarged and demonstrates heterogeneous echotexture; occasionally subtunica fluid, hydrocele, and mediastinal striations are seen. Type II-Testicular size is normal but echotexture is heterogeneous. Type III-The testicle is markedly small with disordered echogenecity. Testicular Doppler flow is absent in all types. Neonatal torsion is rare with only a few cases of bilateral torsion reported. Differential diagnosis is limited. Hernia is common in this age group but easily differentiated from the testicle. Trauma, infection and germ cell tumors are exceedingly rare at this age. Findings US-1) Enlarged and markedly heterogeneous left testicle with dystrophic calcifications and some subtunica fluid, 2) Mildly heterogeneous right testicle with enlarged and cystic epididymis, 3) Absent testicular flow on color Doppler. Reference Traubici J, Daneman A, Navarro O, Garcia C. Testicular torsion in neonates and infants: Sonographic features in 30 patients. AJR (2003); 180:1143-1145. Contributor Corie Horness, RDMS

Bilateral Antenatal Testicular Torsion · Bilateral Antenatal Testicular Torsion Discussion Neonatal testicular torsion is a unique clinical entity. Most patients present with scrotal

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Page 1: Bilateral Antenatal Testicular Torsion · Bilateral Antenatal Testicular Torsion Discussion Neonatal testicular torsion is a unique clinical entity. Most patients present with scrotal

Bilateral Antenatal Testicular TorsionJoseph Junewick, MD FACR

02/09/2010

History5 day old with firm bilateral scrotal masses.

DiagnosisBilateral Antenatal Testicular Torsion

DiscussionNeonatal testicular torsion is a unique clinical entity. Most patients present with scrotal swelling anddiscoloration. Torsion involves all contents of the hemiscrotum and is referred to a extravaginal sincethe tunica albuginea is only loosely adhered to the scrotal wall (in adolescents and adults, torsion isintravaginal).Traubici et al. describe 3 US appearances of neonatal torsion which likely reflect the natural evolution:Type I-The testicle is markedly enlarged and demonstrates heterogeneous echotexture; occasionallysubtunica fluid, hydrocele, and mediastinal striations are seen. Type II-Testicular size is normal butechotexture is heterogeneous. Type III-The testicle is markedly small with disordered echogenecity.Testicular Doppler flow is absent in all types. Neonatal torsion is rare with only a few cases ofbilateral torsion reported.Differential diagnosis is limited. Hernia is common in this age group but easily differentiated from thetesticle. Trauma, infection and germ cell tumors are exceedingly rare at this age.

FindingsUS-1) Enlarged and markedly heterogeneous left testicle with dystrophic calcifications and somesubtunica fluid, 2) Mildly heterogeneous right testicle with enlarged and cystic epididymis, 3) Absenttesticular flow on color Doppler.

ReferenceTraubici J, Daneman A, Navarro O, Garcia C. Testicular torsion in neonates and infants: Sonographicfeatures in 30 patients. AJR (2003); 180:1143-1145.ContributorCorie Horness, RDMS

Page 2: Bilateral Antenatal Testicular Torsion · Bilateral Antenatal Testicular Torsion Discussion Neonatal testicular torsion is a unique clinical entity. Most patients present with scrotal

Page 3: Bilateral Antenatal Testicular Torsion · Bilateral Antenatal Testicular Torsion Discussion Neonatal testicular torsion is a unique clinical entity. Most patients present with scrotal

Page 4: Bilateral Antenatal Testicular Torsion · Bilateral Antenatal Testicular Torsion Discussion Neonatal testicular torsion is a unique clinical entity. Most patients present with scrotal

Page 5: Bilateral Antenatal Testicular Torsion · Bilateral Antenatal Testicular Torsion Discussion Neonatal testicular torsion is a unique clinical entity. Most patients present with scrotal

Page 6: Bilateral Antenatal Testicular Torsion · Bilateral Antenatal Testicular Torsion Discussion Neonatal testicular torsion is a unique clinical entity. Most patients present with scrotal

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