Testicular torsion revisited

Ultrasound is routinely used for the assessment and diagnosis of testicular torsion. It has proven to be a reliable and necessary diagnostic tool for the urologist. Problems, however, can arise in the form of misdiagnosis when the basic pathophysiology and clinical presentation of testicular torsion are not clearly understood. In this pictorial review, we present the spectrum of the appearance of testes with testicular torsion. This includes both complete and incomplete torsion. The critical use of Doppler and the interpretation of the Doppler findings will be presented. Other abnormalities that can be potentially confused with testicular torsion, including epididymitis and orchitis, will be shown. An approach to assessing the testis that stresses the critical role of both Doppler examination and an understanding of the clinical presentation will be presented. In particular, in incomplete torsion, a Doppler examination will still demonstrate flow to the testis, potentially leading to a missed diagnosis if the clinical presentation is not considered. Examples of normal and abnormal anatomy will be presented.