0:00

This was a one day old male who was born at full term,

0:04

but in the, uh, newborn nursery was noted

0:07

to have some firmness

0:09

and discoloration of the scrotum on exam.

0:13

So they were concerned for neonatal testicular torsion,

0:16

and this patient underwent scrotal ultrasound.

0:19

We're continuing our, uh, theme of GU imaging.

0:22

So this first image is a great, uh, a color image

0:26

of both the right and left hemi scrotum.

0:29

And you can see already that we have

0:31

relative normal perfusion of the right scrotum.

0:34

But, uh, not only do we not have perfusion

0:36

of the left testicle, we have a heterogeneous appearance

0:41

of the left testis.

0:43

So, um, we have a side-by-side comparison image

0:47

demonstrating normal, uh, echogenicity normal perfusion

0:51

with color doppler imaging of the right testis,

0:53

but a very heterogeneous echogenicity of the left testis.

0:58

We have a little bit of reactive hydrocele surrounding

1:00

that left testis and we have no color doppler perfusion.

1:05

The last thing to point out with

1:06

that abnormal gray scale appearance of

1:08

that left testis is uh, what we call sal edema.

1:11

So we'll, we'll, uh, go look at the,

1:14

not only the still images of that left testis,

1:17

but we'll look at the, uh, cinematic images as well.

1:20

Um, on the right side,

1:21

we do have a hydro seal on the right side as well.

1:24

A reminder that the processes page vaginal is patent

1:28

normally in males up to one year of age.

1:31

So you can see some, uh, some hydro seal

1:34

or fluid accumulation

1:35

because there's an, a communication, um,

1:38

between the abdominal cavity,

1:40

which has normal physiologic fluid and the, um,

1:44

and the, um, and the scrotum

1:46

because of the pa normally patent processes, vaginalis.

1:49

So we have normal right testis, um, normal volume of, uh,

1:54

of the right testis.

1:56

Um, we just have some, uh, fluid,

1:58

simple appearing hydrocele surrounding that right testicle.

2:02

We have normal arterial, subtle arterial

2:05

and normal venous flow on that right side.

2:08

The tech has measured the epidural head on this right side.

2:12

We don't actually see any fluid in, uh, the inguinal canal,

2:16

but we also don't see any twisting of cord structures.

2:19

Um, we have normal blood vessels in that, uh, right, um,

2:22

right inguinal canal.

2:24

Then when we go onto the left side, the abnormal side,

2:27

we have marked abnormalities.

2:30

So we have a very heterogeneous appearance

2:32

of the left testis.

2:34

We have, uh, uh, these radiating lines are,

2:39

uh, is prominent septa, um, of the, of this, um,

2:44

this left testis, um,

2:46

radiating from the media signum testis.

2:49

Um, we have prominence

2:51

of the Tuni Eugenia surrounding this left testis.

2:55

And um, uh, we have a reactive

2:58

Hydrocele surrounding the, that, uh, abnormal left testis.

3:03

Not only that, we have a little bit of wall thickening of

3:06

that left hemi scrotum.

3:08

Um, when we go onto color doppler, um, perfusion, looking

3:12

to see any flow of this left testis we see nothing at all.

3:16

So, um, we put spectral tracing on the left test is trying

3:19

to find any either arterial blood flow or venous blood flow.

3:23

And then this is an attempt at looking

3:25

for teeny tiny amounts

3:26

of blood flow using a superb microvascular

3:29

imaging technique.

3:30

Um, uh, blood flow would be sort of a, an amber color.

3:34

It should, should look like this.

3:36

Over here, here there's no blood flow

3:37

that we can see whatsoever.

3:39

The left epididymus is more normal in appearance.

3:42

Um, and that is, uh, commonly seen in these cases

3:46

of newborn testicular torsion, which is an intravaginal, uh,

3:50

testicular torsion.

3:52

And unfortunately this is a case

3:53

of mist in utero testicular torsion.

3:56

So not only is there absent blood flow,

3:58

but we already see changes to the gray scale appearance

4:01

of this left testis with that, um, uh, like, uh,

4:05

marked heterogeneity of the scrotal parenchyma

4:09

and then those like, uh, the septal edema, uh,

4:12

radiating from the mediacy testis into the,

4:16

the parenchyma of the left testis.

4:18

So this is a case of, um, in utero, uh,

4:22

like longstanding in utero,

4:24

testicular torsion on the left side.

4:26

The right was normal, aside from the hydro seal on

4:29

that right side.