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Ruling out Testicular Torsion: Still No Fail Safe Test

Acute scrotal complaints in children are common, and diagnosing testicular torsion is critical. Color Doppler ultrasound is a rapid, noninvasive diagnostic test used to rule out torsion, but there have been some documented missed cases with this method. These researchers reviewed the records of 130 patients younger than 23 years who underwent color Doppler US for evaluation of acute scrotal complaints of low or equivocal suspicion for torsion.

Torsion was diagnosed when flow was absent or significantly lower in the symptomatic testis than in the asymptomatic testis. Epididymitis accounted for 38.5% of final diagnoses and torsion for 13.8%. US was negative for torsion in 110 patients, who thus did not have surgery; 25 of these patients were lost to follow-up, and 2 underwent delayed orchiectomy for testicular atrophy. Of 3 patients diagnosed with intermittent torsion, 2 were lost to follow-up and 1 had elective orchiopexy. The 17 patients with US-diagnosed torsion all underwent surgery; 9 had necrotic testes, 7 had torsed but viable testes, and 1 was found not to have torsion. The overall sensitivity of color Doppler US was 88.9%, and the specificity was 98.8%.

Comment: The low follow-up rate (23% attrition) is disturbing because patients with problems may have sought care elsewhere. At many centers, color Doppler US is already the test of choice for ruling out torsion when history and examination are equivocal; these data reinforce that, even when US is negative for torsion, continued evaluation is indicated when clinical concern remains or when an alternative diagnosis is not clearly established.

— JM Baren

Published in Journal Watch Emergency Medicine June 1, 2000

Citation(s):

Baker LA et al. An analysis of clinical outcomes using color Doppler testicular ultrasound for testicular torsion. Pediatrics 2000 Mar 105 604-607.

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