Ultrasonographic findings in testicular appendage torsion in children and correlation with surgical and histopathologic findings

Abstract

Objective: The purpose of our study was to determine the ultrasound findings in the testicular appendage torsion, the sensitivity and specificity of the method, and the correlation with surgical and histopathologic findings.

Subjects and method: During 5 years 227 boys of age 2 to 13, with acute scrotal pain, were referred from the pediatric surgery emergency department for scrotal US evaluation. In 40 of the patients, a diagnosis of appendix testis torsion was made, and underwent surgery. These patients were our study group. After the clinical evaluation, the following clinical diagnoses were made: suspected testicular torsion in 22 patients, suspected appendix testis torsion in 8 patients, and suspected epididymitis or orchitis in 10 patients. 7 patients had the “blue dot sign” on physical examination.

Results: On gray-scale US all patients showed a round lesion with heterogenous echotexture adjacent to the upper pole of the testis/epididymis with a diameter >6mm. Scrotal skin thickening was seen in 16 (40%) of the cases and a hydrocele was found in all of the cases. On color Doppler images, the torsed appendage was avascular, and in 20 (50%) patients we observed hyperemia in the surrounding tissues.

Conclusion: Torsion of the testicular appendages has a set of features on the multiparametric US. Thus, we believe that it is the method of choice for diagnosing torsion of the scrotal appendages and safely ruling out other disorders as well as avoiding unwarranted surgical intervention or antibiotic treatment. The identification of a testicular appendage larger than 6 mm is suggestive of torsion.