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History 19-year-old male with acute right scrotal pain for the last 5 hours No fever, dysuria, nausea and vomiting No previous pain episodes No history.

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Presentation transcript:

Figure 7: A 35-year-old male presented to the emergency department with left scrotal pain. (a) Gray scale ultrasound demonstrates an enlarged, edematous left testis. (b) Color flow and spectral Doppler show no flow. (c) Corresponding histopathology (H&E, 200) demonstrates seminiferous tubules lined with viable (arrowhead) and nonviable (arrow) cells. Vasculitis can cause vasospasm, resulting in slow blood flow unable to be detected by ultrasound technology. Color flow Doppler ultrasound is unable to detect blood flow when the flow rate is less than 6 cm/second. As evidenced by histopathology, the testis was viable in this patient. However, due to inability of ultrasound to detect slow flow, this case was wrongly diagnosed as testicular torsion. Vasculitis or other causes of vasospasm should be considered in select cases. Reproduced with permission from Lin EP, Bhatt S, Rubens DJ, Dogra VS. Testicular Torsion: Twists and Turns. Seminars in Ultrasound, CT and MRI. 2007;28(4):317-28. (These figures are reproduced with permission from Allison Forrest, Akshaar Brahmbhatt, Vikram Dogra. Decreased Blood Flow in the Testis: Is it Testicular Torsion&quest;. Am J Sonogr 2018 1(13) 1-7)