Testicular torsion: pitfalls of color Doppler sonography

Only 25% of boys with acute scrotal swelling have testicular torsion. A noninvasive test that reliably distinguishes torsed testes from all other acute scrotal conditions would benefit patients presenting with pain and swelling of the scrotum. Recent reports suggest that color Doppler ultrasound may be the long-awaited test that clearly differentiates testes with compromised blood flow from all other conditions. However, we report on 2 patients with positive blood flow on color Doppler ultrasonography who subsequently were found at surgery to have testicular torsion. Inability to distinguish normal testes and normal epididymis on physical examination is still the best indicator to proceed with surgical exploration in pediatric patients with acute scrotal swelling.