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Reading File
Finding Sources
Finding Sources
Reading File
Reading File
Here is a full clinical interpretation of this USG report:
USG Inguino-Scrotal Report - Clinical Interpretation
Patient: Avdhut Manoj Adsul | 21 years/M | H/O Trauma, Left Testicular Pain
Study: USG Inguino-Scrotal Region (Follow-up scan after 4 hours, Faculty Review)
Date: 09/08/2026
Summary of Findings
| Parameter | Right (Normal) | Left (Abnormal) |
|---|---|---|
| Testis Size | 4.5 x 2.2 x 2.1 cm | 4.7 x 2.6 x 3 cm (enlarged) |
| Testis Margins | Normal | Irregular |
| Testis Echogenicity | Normal | Altered |
| Testis Echotexture | Normal | Mildly heterogeneous |
| Testis Lesions | Nil | Nil |
| Testis Color Doppler | Normal | Increased vascularity |
| Epididymis Size | 15 x 6 mm | 21 x 10 mm (enlarged) |
| Epididymis Echogenicity | Normal | Altered |
| Epididymis Echotexture | Normal | Hypoechoic |
| Epididymis Color Doppler | Normal | Reduced |
| Extra-testicular | Spermatic cord - Normal | Minimal hydrocele; Spermatic cord as below |
| Inguinal Canal | Normal | As described below |
Special Comments (radiologist's conclusion):
- The left spermatic cord is thickened and edematous up to the inguinal region
- Shows a partial whirlpool sign with increased vascularity
- Patent proximal and distal vascularity is present
- Diagnosis: Partial Torsion of the Left Spermatic Cord with enlarged, hypoechoic epididymis secondary to venous congestion and testicular hyperemia
- Scrotal wall edema noted predominantly on the left
What This Means Clinically
1. Partial (Incomplete) Spermatic Cord Torsion
This is the key diagnosis. In partial torsion (typically 180° or less of cord twisting), venous outflow is obstructed but arterial flow is partially preserved. This explains why:
- The left testis shows increased (not absent) vascularity on Doppler - venous congestion causes reactive hyperemia
- The epididymis shows reduced flow - because it is more sensitive to venous congestion
- The cord shows a whirlpool sign - the sonographic signature of a twisted spermatic cord
As described in Rosen's Emergency Medicine: "With 180 degrees or less of twisting of the cord, venous flow from the testicle ceases but arterial flow persists. This leads to edema of the testicle on ultrasound that can be misinterpreted as inconsistent with torsion." This is exactly the pattern seen here.
2. Why This Is Still a Surgical Emergency
The persistence of some blood flow does NOT rule out torsion or reduce urgency. Campbell-Walsh Urology states: "When findings are suspicious for spermatic cord torsion, emergent scrotal exploration is required with the goal of the patient getting to the operating room within 4 hours of onset of pain."
The 4-hour window is referenced directly in the scan title ("Follow-up scan after 4 hours/Faculty Review") - this is tracking the time-sensitive window.
3. The Whirlpool Sign
This is the direct ultrasound sign of a twisted cord - the spermatic cord structures spiral around each other, creating a whirlpool appearance on real-time ultrasound. Its presence here strongly corroborates torsion even in the context of preserved distal flow.
4. Secondary Epididymal Changes
The enlarged (21 x 10 mm vs. normal 15 x 6 mm on the right), hypoechoic, hypovascular left epididymis reflects venous congestion from the torsion - not primary epididymitis. The radiologist correctly attributes this to venous congestion, not infection.
5. Mildly Heterogeneous Testis Texture
This is an important finding. Homogeneous echotexture indicates viability. The mild heterogeneity noted here suggests early ischemic change, but the testis may still be salvageable. Significant heterogeneity would indicate non-viability.
Recommended Management
This is a urological emergency requiring immediate surgical exploration:
- Urgent surgical scrotal exploration - do NOT wait for further imaging or observation
- Detorsion of the left spermatic cord intraoperatively
- Orchidopexy (fixation) of the left testis if viable
- Contralateral orchidopexy of the right testis (prophylactic, as the underlying "bell-clapper" deformity is bilateral in ~80% of cases)
- If testis is non-viable at exploration - orchiectomy
Note: The fact that this is a follow-up scan "after 4 hours" with a partial whirlpool sign and preserved but abnormal flow means the testis is at immediate risk. Every minute of additional delay reduces the chance of salvage. Testicular salvage rates drop sharply: ~90-100% within 6 hours, ~50% at 12 hours, and ~10% beyond 24 hours.
Differential Diagnoses (less likely given findings)
- Epididymo-orchitis - would show uniformly increased epididymal flow, not reduced; no whirlpool sign
- Traumatic orchitis - possible given H/O trauma, but whirlpool sign favors torsion
- Torsion of appendix testis - typically a small hypervascular nodule; different picture
Bottom line: This USG report is highly suggestive of partial left spermatic cord torsion in the context of trauma. The presence of the whirlpool sign is essentially diagnostic. This patient requires emergency surgical exploration without further delay - the imaging itself should not delay the urologist's evaluation or the OR booking.
- Rosen's Emergency Medicine, Imaging section (testicular torsion)
- Campbell-Walsh Wein Urology, Scrotal Conditions (spermatic cord torsion)
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