So let's take a look at this case.
We have 4 ultrasound images of the scrotum here.
Let's take a look at each one of these individually.
So this is a normal ultrasound image without Doppler.
Just take a look at the echo texture of the testicle
and compare it with the previous normal ones that we take a look at.
This a Doppler evaluation.
So a color Doppler evaluation of the left testicle.
Again you can see actually very little flow.
We have just a little blip of flow over in the corner here
but there's really no other flow to that testicle.
This a spectral evaluation of the same testicle
so you can see here there actually is no spectral wave form identified.
So not only is there no color, there's also no spectral wave form identified
and then here is the comparison of the two testicles side by side.
So this is an example of the normal right testicle
and then here we have the abnormal left testicle.
So the images demonstrate a slightly heterogeneous hypoechoic testicle
which has no color, or spectral flow in Doppler evaluation.
And this is an example of testicular torsion.
In this patient the testicle looks like it is still salvageable.
It doesn't look like it's shrunken in size.
And although it's slightly hypoechoic, it's not significantly hypoechoic.
So this is a patient that immediately needs surgical detorsion.
So when we see testicular torsion on ultrasound,
the next step is to call urology immediately for detorsion.
This is a surgical emergency.
And there is an 80 to a hundred percent chance of salvage
if the testicle is detorsed within 6 hours.
There's really no chance of salvage unfortunately,
if it has already been 24 hours.
It's important to remember that normal ultrasound
does not exclude early or partial torsion.
Early torsion may have no ultrasound findings
and partial torsion which is a testicle that torses and detorses
may also not have any findings if you're catching it at a phase
in which it is in its normal position.
So if we do have a clinical suspicion of torsion
that we don't see on the ultrasound,
it's important to remember to repeat that ultrasound within 4 hours.
So let's discuss testicular carcinoma.
Any solid mass that's within the testicle
should raise a suspicion for carcinoma.
The first line of imaging in a patient that presents with the palpable mass
is an ultrasound. So let's take a look at these ultrasound images.
These are both ultrasound images of the right testicle.
You can see here that this is a non-Doppler standard ultrasound image
and then image on the right is a Doppler image
which does show some color flow to the testicle.
Again compare these with some of the normal ones that we saw previously.
The testicle appears very heterogeneous.
There's a heterogeneous solid mass within it that has increased blood flow.
Testicular cancers can often metastasize to the para-aortic lymph nodes.
So whenever we see a testicular mass,
the next step should always be to do a CT of the abdomen and pelvis
to look for staging, to look for abnormal lymph nodes.
Lung metastases are also very common
so a chest x-ray is usually done in conjunction.
This is an example of a patient
that actually did have metastatic testicular carcinoma.
So this is a coronal CT image of the abdomen
and you can see here, this is the normal aorta.
And then adjacent to it you see this small soft tissue densities
which represent enlarged para-aortic lymph nodes
and this is a common location for a testicular cancer to metastasize.