Sonography of Intrascrotal Appendage Torsion Varying Echogenicity of the Torsed Appendage According to the Time From Onset

Abstract

Objectives-The purpose of this study was to evaluate sonographic findings in torsed intrascrotal appendages and to assess the effect of the time from symptom onset on echogenicity and the relationship between the time from symptom onset and manual reduction success. Methods-Thirty-five boys (6-13 years old; mean, 9.9 years) with torsion of an intrascrotal appendage were evaluated. All had painful unilateral scrotal swelling and palpable tender nodules on physical examination and underwent sonography. Thirty-two underwent subsequent manual reduction. Before manual reduction, we assessed the size, echogenicity, appendage blood flow, periappendiceal blood flow, and scrotal swelling. Data were analyzed according to time from symptom onset. After manual reduction, the number of reduction trials, pain relief, size, and blood flow of the appendix testis were assessed. Results-The torsed appendage was hypoechoic in all 17 boys assessed within 24 hours of symptom onset. In boys assessed more than 24 hours after onset, the torsed appendage was hypoechoic in 6, isoechoic in 4, and hyperechoic in 8. Twenty-two of 23 hypoechoic appendages showed a salt-and-pepper pattern. The echogenicity differed significantly between boys assessed within and more than 24 hours after symptom onset (P < .001). The success rates of manual reduction were 90.9% (20 of 22) for hypoechoic appendages, 75.0% (3 of 4) for isoechoic appendages, and 50.0% (3 of 6) for hyperechoic appendages. Sonography revealed increased blood flow and decreased appendage sizes in all boys with successful reduction. Conclusions-The echogenicity of a torsed appendage changes according to the time from onset. A hyperechoic intrascrotal appendage is associated with later sonography and is a poor predictor of manual reduction success.