A 14-year-old boy with acute scrotal pain; which diagnostic test is most helpful to confirm testicular torsion?

A 14-year-old boy with acute scrotal pain; which diagnostic test is most helpful to confirm testicular torsion?

• A. Transillumination
• B. Doppler Ultrasound
• C. Urine Cultures and Sensitivity
• D. Serum Human Chorionic Gonadotropin Levels

Answer: (B)

In acute scrotal pain, the priority is to confirm torsion quickly because salvage depends on rapid detorsion. The most helpful test is color Doppler ultrasound, because it directly assesses blood flow to the testis. In torsion, arterial inflow can be reduced or absent, and venous outflow is obstructed, producing an avascular or hypovascular testis on Doppler compared with the opposite side. This perfusion information not only supports the diagnosis of torsion but also helps distinguish it from epididymo-orchitis, where blood flow to the testis is typically increased or preserved due to inflammation. Other options are less reliable for confirming torsion. Transillumination is not specific or sensitive for torsion and can be misleading. Urine cultures and sensitivity address infection, not torsion. Serum human chorionic gonadotropin levels are not relevant to acute torsion in a 14-year-old. If clinical suspicion is very high, surgical exploration should not be delayed for imaging, but Doppler ultrasound remains the best initial, noninvasive test to confirm torsion and guide urgent management.

In acute scrotal pain, the priority is to confirm torsion quickly because salvage depends on rapid detorsion. The most helpful test is color Doppler ultrasound, because it directly assesses blood flow to the testis. In torsion, arterial inflow can be reduced or absent, and venous outflow is obstructed, producing an avascular or hypovascular testis on Doppler compared with the opposite side. This perfusion information not only supports the diagnosis of torsion but also helps distinguish it from epididymo-orchitis, where blood flow to the testis is typically increased or preserved due to inflammation.

Other options are less reliable for confirming torsion. Transillumination is not specific or sensitive for torsion and can be misleading. Urine cultures and sensitivity address infection, not torsion. Serum human chorionic gonadotropin levels are not relevant to acute torsion in a 14-year-old.

If clinical suspicion is very high, surgical exploration should not be delayed for imaging, but Doppler ultrasound remains the best initial, noninvasive test to confirm torsion and guide urgent management.