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Joseph Junewick, MD FACR
over 11 years ago
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Case Detail

Anatomy: Genitourinary
Heather Borders, MD
Diagnostic Category: Vascular
Created: over 10 years ago
Updated: over 10 years ago
Tags: PEDS
Modality/Study Types: US
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13 year old male with a two day history of testicular/scrotal pain

Case Images


Testicular torsion with testicular infarction


Enlarged heterogeneous left testicle with multiple internal foci of hyperechogenicity and absent color flow with Doppler interrogation.


Testicular torsion results in venous obstruction followed by arterial obstruction and eventual infarction. The time to infarction depends on the duration of the ischemia and the degree of vascular occlusion. Infarction may occur as early as four hours after symptom onset. In this case, the patient had symptoms for two days.

Gray scale sonography may not be helpful in the early stages of ischemia and may show only decreased testicular echogenicity, swelling and reactive hydroceles. If the testis is normal on gray scale, it is more likely to be viable. If inhomogenous, it is more likely to be infarcted.

Color doppler imaging is useful to demonstrate absent or asymmetrically decreased blood flow.

In this case, the testis was black at surgery and at pathology showed evidence of hemorrhagic infarction.

The appearance of the testicle in this case resembles lipomatosis associated with Cowden syndrome and also raises concern for a mass. However, the history of pain and absence of color flow as well as asymmetry makes torsion and infarction most likely.


Multiple hyperechoic foci in the testis of patients with Cowdens syndrome are common and represent lipomatosis; The British Journal of Radiology. 79(2006) 801-803.

Ultrasound: The Requisites. Middleton pp. 170-171.

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