Torsion of Undescended Testis in Children Detected By Point-of-Care Ultrasound

Torsion of undescended testis (UDT) is a rare urological emergency requiring immediate intervention to salvage the affected testis. Ultrasonography is used for identifying torsion of UDT, but it is mostly performed by radiologists or urologists. Point-of-care ultrasound (POCUS) is currently used in pediatric emergency care but reports of its use for diagnosing torsion of UDT are scarce.

A previously healthy 11-year-old male patient presented to our emergency department (ED) complaining of swelling of his left inguinal area with mild pain. He denied having any fever, vomiting, or diarrhea. Vital signs were appropriate for his age. Physical examination revealed an approximately 3 cm, hard, and tender mass over his left inguinal area without erythema or fluctuation. No mass was palpated over the right inguinal area. POCUS showed an empty left scrotal sac, and an oval-shaped, homogeneous, hypoechoic structure suggestive of a testis in the left inguinal area. POCUS also detected a hyperechoic structure posterior to the left testis with a whirlpool sign, indicating a twisted spermatic cord. Based on the POCUS findings, the patient was referred to the pediatric surgeon for concern of torsion of UDT. Radiology department ultrasonography also suggested torsion of UDT, and urgent surgical exploration was performed. Torsion of UDT was confirmed and orchidopexy done. The patient was discharged without any complications on the second post-operative day. WHY SHOULD AN EMERGENCY PHYSICIAN BE AWARE OF TTHIS?: Torsion of UDT is often challenging to diagnose due to its atypical presentation. POCUS can directly visualize structures in the inguinal canal to differentiate potential causes, empowering physicians to diagnose torsion of UDT promptly and optimize patient care.