Call Girls Hebbal Just Call 7001305949 Top Class Call Girl Service Available
Torsion testis final
1. Dr Arun Gupta
Director imaging
Dr Rakhee gupta
Dr R K S Gandhi
Dr Vinayak Mittal
Dr Ritesh Mahajan
TORSION TESTIS
2. TORSION TESTIS
Torsion is more common in boys than in men, and it
represents only 20% of the acute scrotal pathologic
phenomena in postpubertal males. However, prompt
diagnosis is necessary because torsion requires
immediate surgery to preserve the testis.
Acute
Sub-Acute
Chronic
------------------
Intra- Vaginal
Extra -Vaginal
NORMAL TORSION
3. The tunica vaginalis does not completely
surround the testis and epididymis, which
are attached to the posterior
scrotal wall .
Bell-clapper anomaly. The tunica
vaginalis completely surrounds the testis,
epididymis,and part of the spermatic cord,
predisposing to torsion.
Intravaginal torsion. Bell-clapper
anomaly with complete torsion of the
spermatic cord, compromising the blood
supply to the testis.
Extravaginal torsion in a neonate.
Tunica vaginalis is in normal position, but
abnormal motility allows rotation of the
testis, epididymis, and spermatic cord.
4. NORMAL
ORIENTATION OF
THE RT SIDE
TESTIS IS
APPRECIATED
AND
CHANGE IN THE
LONG AXIS OF THE
LEFT SIDE TESTIS
IS SEQUEL TO
TORSION
( BELL CLAPPER
MORPHOLOGY) .
NORMAL TORSION
SEQUAEL
5. COMPARISON
BETWEEN NORMAL
AND ISCHEMIC
TESTIS .
NORMAL RT TESTIS
HAS MIDLEVEL ECHOES
OF THE PARENCHYMA
WITH SLOW FLOW
VASCULARITY .
HYPOECHOIC /
HETEROGENOUS
ECHOGENECITY OF
LEFT TESTIS ( EARLY
TORSION).
HYPERECHOIC
ECOPATTERN CAN BE
SEEN WITH INFARCTION
/ HAEMORRHAGE ALSO
NORMAL
TESTIS
TORSION
SEQUAEL
NORMAL
INTRAPARENCHYMAL
VASCULARITY
6. CORD TESTIS
EPIDYDIMIS
COMPLEX
1. EPIDYDIMIS may
be enlarged and can
not be appreciated
as separate from the
cord leading to
formation of
CORD /
EPIDYDIMIS
COMPLEX.
2. EXTRATESTICULAR
MASS CAN BE
SEQUAEL TO
HAEMORRGAE IN
EPIDYDIMIS /
TUNICA VAGINALIS
7. Circumferential swirl of the vessels is appreciated
proximal to the torison site . Distal to the swirl there is no
color fill .
TORSION KNOT
The spermatic cord immediately proximal to the
testis and epididymis is twisted, causing a
characteristic torsion knot or “whirlpool
pattern” of concentric layers.
8. HIGH RESISTANCE
ARTERIAL FLOW IS
APPRECIATED JUST
PROXIMAL TO THE
TORISON SITE
REACTIONARY
INCREASE IN THE
THICKNESS OF THE
SCROTAL SUBCUTIS
PLANE WTH
INCREASED
VASCULARITY OF THE
PARATESTICULAR
TISSUES ( DARTOS
FASCIA )
9. TORSION TESTIS
In torsion,blood flow is absent in the affected testicle or significantly less than in
the normal, contralateral testicle.
NO BLOOD FLOW IS APPRECIATED IN THE EPIDYDIMIS /TESTIS COMPLEX
DISTAL TO SWIRL OF BLOOD FLOW REPRESENTING THE TORSION SITE
TORSION KNOT
11. Potential pitfalls ….while diagnosing torsion
PARTIAL TORSION : Torsion of at least 540 degrees is
necessary for complete arterial occlusion .With partial torsion of
360 degrees, or less, arterial flow may still occur, but venous
outflow is often obstructed causing diminished diastolic arterial
flow on spectralDoppler examination.
TORSION/DETORSION :If spontaneous detorsion occurs,
flow within the affected testis may be normal, or it may be
increased and mimic orchitis. Spontaneous detorsion rarely
occurs and leaves a segmental testicular infarction.
ISCHEMIA FROM ORCHITIS :Segmental testicular
infarction may also occur with Henoch-Schönlein purpura or
with orchitis . Orchitis may also cause global ischemia of the
testis and mimic torsion.