Testicular torsion in crytporchidism- Unravelled

Congress:

ECR 2018

Poster Number:

C-2664

Type:

Educational Exhibit

Keywords:

Haemorrhage, Congenital, Acute, Contrast agent-intravenous, CT, Genital / Reproductive system male, Emergency, Abdomen

Authors:

N. Perothayil¹, A. Rohatgi¹, P. P. WALI², D. SAGAR G², M. Kumar³, S. R. Khan³, R. Gowda³, R. V. Helavar³; ¹Bengaluru/IN, ²BANGALORE, KARNATAKA/IN, ³bangalore/IN

DOI:

10.1594/ecr2018/C-2664

DOI-Link:

https://dx.doi.org/10.1594/ecr2018/C-2664

Fig. 2: Ultrasonography: Bulky, heterogeneous left testis with no vascularity on color...

Fig. 3: Axial unenhanced CT of pelvis: Left undescended testis (*) just proximal to the...

Fig. 4: Axial unenhanced CT of pelvis: Empty left inguinal canal (Arrow).

Fig. 5: Axial unenhanced CT of pelvis: Post left orchidectomy with left prosthetic...

Learning objectives

To evaluate role of imagingin assessment of testicular torsion in cryptorchidism, a rare urological emergency.

Background

EMBRYOLOGY: Fig. 1 Male gonads arise from the urogenital ridge along posterior abdominal wall, near kidneys. They undergo descent throughout gestation to inguinal canal under the effect of anti-mullerian hormone. Thereafter, inguino-scrotal transition occurs in the third trimester along the tunica vaginalis under the effect of testosterone, produced by fetal testis. PATHO-PHYSIOLOGY: Cryptorchidism or undescended testis occurs when the above process gets impeded. It is the most common genitourinary anomaly in pediatric population. It is more common in preterm than term infants. It is usually...

Findings and procedure details

Imaging findings in cryptorchidism with testicular torsion: 1. Ultrasonography (USG) with Doppler: The characteristic findings include: a.Increase in size of testis with decreased echogenicity due to edema. However if the testis is deeply placed (intra-abdominal, pelvis or retroperitoneal), it may not be accessible by ultrasonography. b. Twisting of spermatic cord “Whirlpool Sign” with decreased orabsent blood flow. 2. Computed Tomography (CT): A heterogenous soft tissue density structure showing variable enhancement onpost contrast study anywhere along the line of testicular descent. The spermatic cord is seen...

Conclusion

Testicular torsion in cryptorchidism is a rare urological emergency mandating prompt identification and management. Imaging is of paramount importance in diagnosing this condition in patients with high clinical suspicion to guide early surgical exploration andthus salvage the testis whenever possible.

Personal information

References

S. B. Pillai and G. E. Besner, “Pediatric testicular problems”, Pediatric Clinics of North America, vol. 45, no. 4, pp. 813–830, 1998. Tasian GE, Copp HL, Baskin LS. Diagnostic Imaging in Cryptorchidism: Utility, Indications, and Effectiveness. J Pediatr Surg. 2011 December; 46(12):2406-2413. Naouar S, Braiek S, Kamel RE. Testicular torsion in undescended testis – a persistent challenge. Asian Journal of Urology. 2017; 4:111-115. Ferguson L, Agoulnik AI. Testicular cancer and cryptorchidism. Front Endocrinol (Lausanne). 2013; 4: 32. Mohammad Kazem Moslemi, Mehdi Abedinzadeh, and Shabir Al-Mousawi,...