What imaging should be ordered for suspected testicular torsion?

What imaging should be ordered for suspected testicular torsion?

• A. Abdominal X-ray
• B. Pelvic MRI
• C. Scrotal US w/ Doppler
• D. CT abdomen

Answer: (C)

Suspected testicular torsion is an emergency, so you want a fast way to confirm or exclude compromised blood flow to the testis. Scrotal ultrasound with Doppler is the imaging test of choice because it directly evaluates both testicular anatomy and blood flow. In torsion, the Doppler study often shows reduced or absent arterial flow to the affected testis, and you may see signs like a twisted spermatic cord (whirlpool sign) or heterogeneity if there’s infarction. This modality is quick, widely available, and avoids radiation, making it ideal for ED workups. Other imaging options don’t target the problem as efficiently: abdominal X-ray and CT abdomen don’t image the scrotum, and pelvic MRI, while accurate, is time-consuming and less practical in an emergent setting. If the clinical picture is highly suspicious for torsion, don’t delay definitive treatment for imaging; but when imaging is performed, scrotal ultrasound with Doppler provides the best diagnostic information to guide management.

Suspected testicular torsion is an emergency, so you want a fast way to confirm or exclude compromised blood flow to the testis. Scrotal ultrasound with Doppler is the imaging test of choice because it directly evaluates both testicular anatomy and blood flow. In torsion, the Doppler study often shows reduced or absent arterial flow to the affected testis, and you may see signs like a twisted spermatic cord (whirlpool sign) or heterogeneity if there’s infarction. This modality is quick, widely available, and avoids radiation, making it ideal for ED workups.

Other imaging options don’t target the problem as efficiently: abdominal X-ray and CT abdomen don’t image the scrotum, and pelvic MRI, while accurate, is time-consuming and less practical in an emergent setting. If the clinical picture is highly suspicious for torsion, don’t delay definitive treatment for imaging; but when imaging is performed, scrotal ultrasound with Doppler provides the best diagnostic information to guide management.