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Sonographic Appearance of the Epididymis in Pediatric Testicular Torsion

Hospital Materno-Infantil Vall d-Hebron, Barcelona, Spain

 
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We have carefully read the interesting article by Nussbaum Blask and Rushton [1], "Sonographic Appearance of the Epididymis in Pediatric Testicular Torsion," published in the December 2006 issue of the AJR. The article describes a retrospective study of 50 pediatric patients with unilateral testicular torsion who ranged in age from neonate to 17 years. Most of the illustrations provided are of 15-, 16-, and 17-year-old patients. It is well recognized that testicular torsion in this age group is almost always of the intravaginal type in which the intrascrotal portion of the twisted spermatic cord is engorged and displaces or wraps around the epididymis, taking the form of a snail shell-shaped mass in a supratesticular location. In this situation, it is very difficult or impossible to identify the epididymis as a separate structure on sonograpy, as was clearly mentioned in the Discussion section of the article and supported with data from previous articles (references 22, 23, and 24 in the article).

Nevertheless, no reference to the spermatic cord is made in the legends to the images provided in the article [1]. We think the sonographic findings in most of the figures actually represent both the spermatic cord and epididymis, rather than only the epididymis as is reported. Furthermore, we think that the multiple prominent cystic spaces observed in 13 cases and confirmed as "vascular channels" within the epididymis in two cases or speculated to be "necrosis, hemorrhage, or thrombus within vessels" in the remaining 11 cases, are actually dilated lymph vessels within the spermatic cord, as can be seen in Figure 12A of a study by Aso et al. [2].

These considerations generally do not affect treatment because testicular vascularization is absent or decreased in most patients with testicular torsion, and this guides the management. However, in patients with preserved vascularization, proper recognition of the supratesticular sonographic image as the spermatic cord plus the epididymis is extremely important to avoid an erroneous diagnosis of epididymitis.

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1. Nussbaum Blask AR, Rushton HG. Sonographic appearance of the epididymis in pediatric testicular torsion. AJR2006; 187:1627 -1635[Abstract/Free Full Text]
2. Aso C, Enríquez G, Fité M, et al. Gray-scale and color Doppler sonography of scrotal disorders in children: an update. RadioGraphics 2005;25 : 1197-1214[Abstract/Free Full Text]

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This Article Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Citing Articles Citing Articles via Google Scholar Google Scholar Articles by Enríquez, G. Articles by Aso, C. Search for Related Content PubMed PubMed Citation Articles by Enríquez, G. Articles by Aso, C. Social Bookmarking                      What's this? Hotlight (NEW!) What's Hotlight?