Acute scrotal pain (suspected testicular torsion)
Recommended: Scrotal Ultrasound with Doppler is the preferred imaging study for acute scrotal pain (suspected testicular torsion). Surgical emergency — viability declines after ~6 hours.
Recommended study
Scrotal Ultrasound with Doppler
Surgical emergency — viability declines after ~6 hours. Doppler shows decreased / absent flow. If exam is classic and imaging will delay > 30 min, go to OR directly.
If the default doesn't apply
US non-diagnostic or unavailable, classic exam
Surgical exploration without imaging (do not delay)
No contrast
Watch-outs
Time is testicle
Salvage rate ~100% within 6 hours, declines rapidly after — go to OR if exam is classic and imaging will delay surgery.
Intermittent torsion
Normal Doppler does not exclude torsion if symptoms have resolved — orchiopexy may still be warranted.
Pearls
- Bell-clapper deformity is bilateral — operative bilateral fixation is standard.
- Doppler findings: absent / reduced flow, heterogeneous testis, twisted spermatic cord ('whirlpool' sign).
- Differentiate from epididymitis (preserved or increased flow, focal epididymal pain).