Testicular Torsion: Diagnostic Tests

Scrotal sonography (ultrasound examination of the scrotal organs/testis and epididymis and their vascular supply) using Doppler sonography (special ultrasound examination that measures the flow velocity of blood in the vessels (arteries and veins)):
- Testicular torsion (twisting of the testis) is considered proven with evidence of absence of central perfusion (blood flow of central vessels). Furthermore, the testicular vessels (blood vessels of the testis) in the area of the funiculus spermaticus (bundle of vessels, nerves, and the vas deferens) should be visualized. If these present themselves as a spiral in the course, there is also a high probability of testicular torsion (sensitivity (percentage of diseased patients in whom the disease is detected by the use of the procedure, i.e. a positive finding:) 96 %).
- If a mass (testicular tumor with hemorrhage) is present, this is also detectable by sonography.
- In the case of epididymo-orchitis (epididymitis), hyperperfusion (increased blood flow) of the testis or epididymis can be demonstrated

Doppler sonography (in stone comparison) – assessment of central perfusion (modified after).

Arterial	Negative	positive		positive
Venous	Negative	negative		negative
Further			Central hyperemia
Diagnosis	No perfusion	Inferior perfusion	Orchitis (testicular inflammation)	Additional information needed: e.g., epididymis, hydatid, tumor
Differential diagnoses	Testicular torsion, incarcerated inguinal hernia.	partial torsion of the testis	intermittent testicular torsion

Optional medical device diagnostics – depending on the results of the history, physical examination, laboratory diagnostics, and obligatory medical device diagnostics – for differential diagnostic clarification

Computed tomography (CT) of the abdomen (abdominal CT) – for further diagnosis.
Magnetic resonance imaging of the pelvis (pelvic MRI) or scintigraphy (imaging nuclear medicine procedure) – to assess testicular perfusion.