Radionuclide imaging of sequential torsions of the appendix testis

Radionuclide imaging is the diagnostic procedure of choice for evaluation of acute disorders of the scrotum, permitting rapid differentiation of torsion of the spermatic cord from inflammatory processes. The method is less successful in diagnosing torsion of the testicular appendages. In the majority of reported cases of torsion of the appendix testis the scan appears normal. In a very limited number of cases increased perfusion to the affected side has been noted. We report a case of metachronous torsion of both the appendices testis. In each instance, there was decreased tracer uptake on the affected side, suggestive of early torsion of the testicle. The sequential involvement of each testis with a nine month interval between respective torsions provides a unique example where each testis serves, sequentially, as a normal control for the torsed contralateral appendage.