Purpose or Case Report: Testicular torsion occurs in 3.8 per 100,000 boys and is a medical emergency as salvage of the testicle depends on prompt diagnosis and intervention. Testicular torsion has a bimodal distribution, during the perinatal period where the torsion is extravaginal type, and during puberty where the torsion is intravaginal type.

Newborns may not have pain related symptoms and perinatal testicular torsion can mimic hernia, tumor or epididymitis. In ultrasound (US), comparison of testicular flow to the contralateral testis may be challenging due to both limitation in detecting testicular blood flow in this age group and that increased peritesticular flow can mimic epididymo-orchitis. We will show rare cases of perinatal testicular torsion with preserved testicular flow.

Diagnosing testicular torsion in older age group can be challenging in cases of intermittent testicular torsion or incomplete/partial testicular torsion. Only few children with recurrent hemiscrotal pain have intermittent testicular torsion and US can be normal between the episodes. The purpose of this educational poster is to show limitations and pitfalls of scrotal US in diagnosis of testicular torsion and highlight US features such as spermatic cord whirlpool sign, horizontal testis lie, and epididymal and testicular swelling with normal rather than increased testicular flow. Additionally, we will discuss the potential role of contrast enhanced US that would facilitate timely diagnosis and intervention. We will also show how a swollen and redundant spermatic cord in epididymitis can mimic whirlpool sign as an example of potential pitfall leading to misdiagnosis of testicular torsion.
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