Bedside Ultrasound of a Painful Testicle: Before and After Manual Detorsion by an Emergency Physician

A 26-year-old male presented to the emergency department with sudden-onset right testicular pain beginning 8 hours prior to arrival. He also complained of lower abdominal pain, two episodes of vomiting, and mild diarrhea. He denied fever, dysuria, and penile discharge. His history was remarkable for “surgery for an undescended testicle and double hernia repair” as a child. Physical exam revealed a swollen, tender, high-riding right testicle.

A bedside scrotal ultrasound was performed by an emergency physician. The normal left testicle was examined first to optimize the color settings (Video Clip S1, available as supporting information in the online version of this paper). The ultrasound of the right testicle showed it to be heterogenous, enlarged, without blood flow (Figure 1, Video Clip S2), and surrounded by a small hydrocele. The physician made the diagnosis of testicular torsion and performed a manual detorsion using the “open-book” technique with relief of pain at approximately 540°. An immediate repeat bedside ultrasound confirmed flow to the right testicle and showed the spectral tracing of a typical arterial waveform (Figure 2, Video Clip S3). Urology was notified and a formal ultrasound was interpreted as being consistent with a recently detorsed testicle. The patient was admitted to urology for nonemergent orchiopexy with complete salvage of the affected testicle. The entire process of bedside ultrasound, manual detorsion, and repeat bedside ultrasound took less than 5 minutes.

Figure 1.  Testicular torsion: heterogenous appearance, no blood flow on color Doppler.

Figure 2.  Hyperemic testicle post-detorsion with arterial waveform.