It is important to realize that there are two types of testicular torsion.
The type that is most common and usually seen in older children is the intravaginal torsion: This type occurs within the tunica vaginalis. Intravaginal torsion is related to an anomalous testicular suspension that has been referred to as the bell-clapper anomaly. In many instances, this anomaly may be bilateral.
The type that occurs in the neonatal age group is the so called extravaginal torsion. It most commonly develops prenatally in the spermatic cord, proximal to the attachments of the tunica vaginalis. It occurs when the testes may freely rotate prior to the development of testicular fixation via the tunica vaginalis within the scrotum.
The extravaginal torsion comprises approximately 5% of all torsions. and is often associated with a high birth weight.
Up to 20% of cases are bilateral. Bilateral neonatal torsion can occur at the same time or at different times in utero. The latter can result in a different aspect of the testes at the time of examination.
Torsion of the spermatic cord may interrupt blood flow to the testis and epididymis. The degree of torsion may vary. The extent and duration of the torsion influence both the immediate salvage rate and late testicular atrophy. Testicular salvage most likely occurs if the duration of torsion is less than 6-8 hours. After 24 hours testicular necrosis develops in most patients.
In the case of a neonatal testicular torsion because of the long time between the onset of the torsion and the moment of examination there are nearly always necrotic changes in the involved testis.
Prenatal torsion manifests as a firm, hard, scrotal mass, and is usually asymptomatic. The scrotal skin characteristically fixes to the necrotic gonad.
Traubici et al describe in their article Testicular Torsion in Neonates and Infants: Sonographic Features in 30 Patients in the American journal of radiology 3 types
Type 1.—In type 1 there was marked enlargement with heterogeneity in echogenicity of the affected testicle. No detectable Doppler flow could be detected in the testicle. In a few patients, linear hypoechoic striations were seen, oriented radially from the mediastinum testis A hydrocele occasionally with debris was present with thickening of the surrounding soft tissues (A simple hydrocele was seen in the contralateral scrotum in a few patients.
Type 2.— In these patients, the size of the testicle was normal and symmetric with the uninvolved testicle, the echogenicity was heterogeneous. In a number of patients, peripheral hyperechogenicity was seen. A small hydrocele was present in several patients.
Type 3.—In the third group of patients the testicle was markedly diminished with only a small amount of testicular tissue persisting. Areas of increased echogenicity were seen scattered throughout the testicle. A hydrocele was not observed in these patients.
The different patterns represent stages in the evolution of the process of ischemic necrosis.
In the presented case the testis is small with slight peripheral hyperechogenicity and no hydrocele consistent with a type 2 to 3.
Source: sonoworld.com
Source: sonoworld.com
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