UMEM Educational Pearls


  • Testicular torsion is a straightforward diagnosis ultimately based on lack of blood flow to the affected painful, swollen testicle.
  • Testicular torsion is the most common cause of acute unilateral testicular pain in peripubertal boys due to rapid increase in testicle size during puberty.
  • Infarction begins as soon as after 2 hours of ischemia.
  • There is nearly a 100% salvage rate if blood flow is re-established within 6 hours.
  • Intermittent testicular torsion is challenging to diagnosis due to spontaneous resolution of symptoms and return of normal blood flow during ultrasound.
  • Beware complaints of repeated episodes of acute unilateral testicular pain and swelling.
  • Up to 50% of boys with testicular torsion reported at least one prior similar episode of acute pain and swelling. 
  • Ultrasound findings of a whirlpool sign (spiral-like pattern of spermatic cord), boggy spermatic cord, and a psuedomass of the distal spermatic cord are concerning even in the setting of normal blood flow.
  • Bottom Line: Peripubertal boys presenting with complaints of acute unilateral testicular pain and swelling should always be referred for urgent follow up even if their symptoms have resolved and when ultrasound may show normal blood flow as intermittent testicular torsion can not be ruled out.


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Janetschek G, Schreckenberg F, Mikuz G, Merberger M. Experimental testicular torsion: effect on endocrine and exocrine function and contralateral testicular histology. Urol Res 1998; 16:43–47.

Kamaledeen S, Surana R. Intermittent testicular pain: fix the testes. BJU Int 2003; 91:406–408.

Sung EK, Setty BN, Castro-Aragon I. Sonography of the pediatric scrotum: emphasis on the Ts—torsion, trauma, and tumors. AJR 2012; 198:996–1003.