Testicular torsion on color Doppler ultrasound

The article is professionally consulted by a Doctor of Radiology, Department of Diagnostic Imaging - Vinmec Central Park International General Hospital.

Color Doppler ultrasound is a procedure that helps diagnose a variety of problems related to reproductive health such as: testicular torsion, testicular cancer, orchitis, epididymitis, varicocele. .. Which is very valuable in early diagnosis of testicular torsion, so that the patient can have early surgery, remove the torsion, not have to remove the testicle.

The testicles are an important part of the male sex organ, located between the penis and anus. Each man has two testicles, right and left, located in the scrotum, each weighing about 8-12 grams, and 4-5 cm long.
The main task of this part is to produce sperm, and at the same time to excrete Testosterone, the male sex hormone that determines male characteristics and controls the activity of the reproductive system,...

Testicular torsion is a common gynecological emergency accounting for about 17% of cases of acute scrotal pain. Testicular torsion occurs when the testicles move excessively around the spermatic cord, leading to blockage of the vascular system: arteries and veins. Consequences lead to anemia, acute testicular infarction.
Testicular torsion can occur at any age, but 90% of the time it occurs between the ages of 13 and 21.
Testicular torsion is divided into 2 main groups.
Ectopic torsion: Common in young children and infants because the scrotal ligament is not completely fixed to the scrotal wall, causing the testicle to rotate freely in the scrotum. Torsion in the seminal vesicles: Common in adolescents, due to the high attachment of the seminal vesicles to the spermatic cord, allowing the testicle to rotate around the spermatic cord like a pendulum. At the Viet Duc orthopedic Center each year, there are more than 300 cases of testicular torsion diagnosed, but the rate of testicular preservation is quite low 5%, most of the cases are late, not diagnosed immediately. initial point. This speaks to the importance of accurate diagnosis of testicular torsion at baseline in order to increase the rate of testicular preservation.

Color Doppler ultrasound gives highly accurate results, easy to perform. Testicular ultrasound is the use of sound waves to create an image of the testicles inside the male body.
The pictures taken here will help doctors diagnose the disease. Combined with semen analysis, this is an important step in diagnosing abnormalities of the testes, epididymis, testicular cord, testicular size, testicular effusion or not. Testicular torsion?,..
Doppler ultrasound evaluation of testicular pulse spectrum is very valuable for diagnosing testicular torsion with typical whirlpool signs.

Testicular torsion is a dangerous disease, in bad cases it will lead to unfortunate complications such as testicular atrophy, testicular necrosis. The disease can occur at any age, but is most common in men between the ages of 10 and 25. Testicular Doppler ultrasound will help doctors detect severe or mild testicular torsion for timely treatment.
Ultrasound imaging:
4.1 Acute phase (1-6 h) Color Doppler is the most useful and rapid technique to help diagnose testicular torsion, the affected side testicle is not perfused or perfused less than with the contralateral testis (sensitivity 80-98%, specificity 97-100%, accuracy 97%).
Torsion of the spermatic cord produces a whirlpool sign consisting of concentric rings seen on ultrasound and MRI. The torsion mass is located in the upper or posterior pole of the testicle.
4.2 Late stage (> 24h) Echocardiogram is not uniform with areas of infarction, hemorrhage. There is no color Doppler signal in the torsion testicle but there is increased perfusion in the paratesticular tissues, including the epididymis complex and the scrotal smooth muscle (dartos fascia). torsion/detorsion): If spontaneous detorsion occurs, the arterial spectrum returns to normal or slightly increases (may be mistaken for orchitis)

Treatment of testicular torsion
In case the patient arrives early before 6am: Emergency surgery as soon as possible. In the meantime, it is possible to manually untwist the torsion, re-check with Doppler ultrasound to assess the restoration of vascular circulation. In case the patient arrives late: The testicle has purple-black necrosis and cannot be preserved: Orchiectomy, fixation of the opposite testicle to avoid torsion. The surgery to place an artificial testicle was performed one month after surgery. The golden time for treatment of testicular torsion is only the first 6 hours from the time of pain symptom. If intervention before 6 hours, 100% of patients can save testicles. Between 6-12 hours, the chance of saving the testicle is only 50%, and in the period of 12-24 hours, only 20% will be saved. Therefore, color doppler ultrasound plays an important role in helping treating doctors detect the degree of severe or mild testicular torsion for timely treatment. Color Doppler ultrasound also shows arterial flow or records blood flow in the testicles with radioisotopes.
Vinmec International General Hospital is one of the hospitals that apply routine color Doppler ultrasound technique. Here, a team of highly qualified specialists with extensive experience, ultrasound, diagnosis is therefore very accurate. Not only that, it is also an outstanding prestigious medical facility with the world's leading modern equipment system; owns a comprehensive and professional medical examination, consultation and treatment service; A civilized, polite, safe and sterilized medical examination and treatment space with maximum accuracy and high efficiency in the treatment process.