A young man awoke early in the morning with right testicular pain. There was no history of trauma, fever or dysuria.
The gray scale images are normal. The color Doppler images show that there is no flow in the substance of the right testicle. Flow is seen around the edge of the testicle.
Early in testicular torsion the gray scale imaging is normal, later on the testicle can become hypoechoic and hetrogenous. The absence of flow on the painful side is diagnostic of torsion. It must be noted, however, that the presence of flow on doppler imaging does NOT exclude torsion due to the occurrence of partial torsion and torsion / detorsion. As a result, some centers recommend that ultrasound not be performed for cases of ?torsion and that all cases proceed to surgical exploration.
Whilst understanding this reasoning, we have found clinician performed ultrasound in the emergency department can expedite the process in those cases where the ultrasound immediately confirms the diagnosis.