Purpose or Case Report: Pelvic and scrotal pain are common emergent presenting symptoms in the pediatric population, and these patients are commonly imaged to evaluated for gonadal torsion. In this educational exhibit we will review the entire spectrum of gonadal and paragonadal torsions in the pediatric population, focusing on clinical presentations, key imaging findings, possible pitfalls in diagnosis, and next steps in management. It is essential for the pediatric radiologist to be familiar with this range of pathology in order to render an accurate and timely diagnosis, particularly given that some (but not all) of these diagnoses require emergent surgery.
Methods & Materials: Illustrative cases of gonadal and paragonadal torsions were selected from the past 5 years at our tertiary-case academic medical center with a dedicated pediatric hospital. Cases include, but are not limited to, the spectrum of ovarian torsion (from subtle findings of torsion in a previously normal ovary to cases of ovarian torsion with an underlying mass), the spectrum of testicular torsion (from a twisted spermatic cord with preserved testicular flow to more severe torsion with testicular infarction), isolated fallopian tube torsion, paratubal cyst torsion, and paratesticular appendage torsion.
Results: A case-based review of pediatric pelvic (gonadal and paragonadal) torsions covering the entire range of presentation of common entities and classic presentations of rare entities will allow the pediatric radiologist to become more confident and competent in the interpretation of ultrasonography performed for these indications, and well as the interpretation of MRI performed for problem-solving.
Conclusions: Suspected gonadal and paragonadal torsions are relatively common indications for imaging, particularly ultrasonography, in the pediatric population. Familiarity with these entities and the entire spectrum of imaging findings will improve diagnostic accuracy and efficiency of interpretation. This is extremely important as the pediatric radiologist plays a key role in making the ultimate diagnosis and distinguishing surgical emergencies from benign self-limited conditions.