January's Case of the Month
Sonographic Findings of Testicular Torsion in a Canine.
Dr. Shadawn Salmond-Jimenez
PATIENT INFORMATION:
Age: 5 year
Gender: Male Intact
Species: Canine
Breed: Presa Canario
HISTORY:
Patient presented after owner noticed sudden significant swelling of the testicles. Client was told to go to the ER overnight if it worsened. Presented that morning for exam and scrotum was greatly enlarged, bruised/erythematous. The left testicle palpated enlarged and firm compared to the right. No history of trauma and patient was kept separate from other dogs. Patient was a breeding male.
IMAGE INTERPRETATION:
The left testicle is mildly increased in size (3.4x4.5cm), rounded in shape with moderately hypoechoic echogenicity. The left epididymis is severely larger than the right. There is no blood flow detected within the left testis and epididymis with color doppler evaluation. There is a pocket of anechoic fluid seen caudoventral to the left testicle.
The right testicle is mildly increased in size (3.2x4.8cm), however normal in shape and echogenicity. Blood flow is detected in the right testis and epididymis with color doppler evaluation.
DIAGNOSIS AND SONOGRAPHIC ANALYSIS:
Left Testicle - the findings are severe - DDx: testicular torsion (benign orchitis vs neoplasia (less likely)
Scrotum - DDx: hemorrhage vs hematoma
CASE OUTCOME:
The patient was immediately sent to surgery for bilateral orchiectomy with scrotal ablation. The patient made a great recovery from surgery.
BRIEF OVERVIEW OF TESTICULAR TORSION
Testicular torsion is rare in dogs and extremely rare cats. Testicular torsion is more common in retained or neoplastic testes compared to normal, scrotal testes. Testes located in the abdomen may be more prone to torsion because of their greater mobility.
Torsion of scrotal testes can occur but the scrotal ligament must be compromised for torsion to occur. Torsion of the spermatic cord leads to compromise of the testicular blood supply. The testicle becomes enlarged from edema and inflammation. Testicular torsion can cause clinical signs that mimic acute abdomen syndrome.
Ultrasonography: The affected testicle may appear enlarged. The torsed testis can appear hyperechoic compared to surrounding mesenteric fat and to the unaffected testicle. The epididymis and spermatic cord typically are dilated. Doppler examination shows decreased to absent blood flow to the affected testicle. Effusion may be present around the testicle. Testicular torsion does not appear to affect blood supply to the opposite testis.
Bilateral orchiectomy is the preferred treatment for testicular torsion. Because cryptorchidism is an inheritable trait, removal of the normal testis is recommended. With appropriate surgical therapy, prognosis for patients without metastatic neoplasia is good. Castration of males, especially cryptorchid males and those with testicular neoplasia, will prevent testicular torsion.
Testicular Torsion Last updated on 8/30/2017. Contributors: Revised by Kari Rothrock DVM Original author was Linda G. Shell DVM, DACVIM (Neurology), 8/25/2010
Top - A sagittal view of the right testicle. The right testicle maintains normal size, shape and echogenicity. Blood flow is detected with color Doppler evaluation.
Bottom – A sagittal view of the left testicle. The left testicle is rounded in shape and moderately hypoechoic in echogenicity compared to the right testicle. A scant pocket of anechoic fluid is visualized ventral to the left testicle. No blood flow is detected within the left testicle with color Doppler evaluation.
Top – The right epididymis (blue arrow), seen cranial to the right testicle) is normal in size and appearance. Strong blood flow is detected within the right epididymis with color Doppler evaluation.
Bottom – The left epididymis is severely dilated (blue arrows). There is no blood flow detected within the left epididymis with color Doppler evaluation.
A special thanks to the staff at the Potomac Animal Wellness Services for this interesting case.