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Sonographic Appearance of the Epididymis in Pediatric Testicular Torsion

Anna R. Nussbaum Blask1 and H. Gil Rushton2

1 Department of Radiology, Children's National Medical Center, 111 Michigan Ave., NW, Washington, DC 20010.
2 Department of Urology, Children's National Medical Center, Washington, DC 20010.


Figure 1
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  		Fig. 1A —Longitudinal images of epididymis in three patients with testicular torsion. Sonogram of 16-year-old boy shows diffuse enlargement of head, body, and tail of epididymis (E) with bilobular shape. Note diffusely increased echogenicity.

 

Figure 2
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  		Fig. 1B —Longitudinal images of epididymis in three patients with testicular torsion. Sonogram of 15-year-old boy shows heterogeneously increased echogenicity of epididymis (E) with globular shape.

 

Figure 3
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  		Fig. 1C —Longitudinal images of epididymis in three patients with testicular torsion. Sonogram of 15-year-old boy shows head of epididymis (E) is enlarged, has isoechoic texture, and is slightly triangular. T = testis.

 

Figure 4
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  		Fig. 2A —15-year-old boy with acute phase torsion that resolved after spontaneous detorsion. Epididymis contains multiple cystic spaces and no flow on sonogram obtained during acute phase torsion.

 

Figure 5
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  		Fig. 2B —15-year-old boy with acute phase torsion that resolved after spontaneous detorsion. Testis is avascular on sonogram obtained during acute phase torsion.

 

Figure 6
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  		Fig. 2C —15-year-old boy with acute phase torsion that resolved after spontaneous detorsion. Sonogram obtained after spontaneous detorsion shows that epididymis has regained flow. Cystic spaces in epididymis are vascular channels.

 

Figure 7
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  		Fig. 2D —15-year-old boy with acute phase torsion that resolved after spontaneous detorsion. Sonogram obtained after spontaneous detorsion shows that testis also has regained flow.

 

Figure 8
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  		Fig. 3A —Acute phase torsion with hyperemic epididymis. 15-year-old boy who underwent imaging after 20 hours of pain. Sonograms show hyperemic epididymis (E) (A) and decreased flow in testis (T) (B). Testis was not salvaged.

 

Figure 9
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  		Fig. 3B —Acute phase torsion with hyperemic epididymis. 15-year-old boy who underwent imaging after 20 hours of pain. Sonograms show hyperemic epididymis (E) (A) and decreased flow in testis (T) (B). Testis was not salvaged.

 

Figure 10
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  		Fig. 3C —Acute phase torsion with hyperemic epididymis. 5-year-old boy who underwent imaging after 12 hours of pain. Sonogram shows hyperemic epididymis (E) with no flow in testis (T). Testis was salvaged.

 

Figure 11
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  		Fig. 4 —Pathologic specimen of infarcted testis (T) and epididymis (E) from 17-year-old boy with late phase torsion shows diffusely swollen epididymis. C = spermatic cord.

 

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