A new approach to the diagnosis of testicular torsion.

The acutely painful, enlarged scrotum has necessitated urgent exploration of the scrotum so as not to miss testicular torsion. This has led to unnecessary operations. The urgency with which the diagnosis is made is particularly important in infants and children for in these patients the signs and symptoms of testicular torsion may be minimal. Since its introduction in 1973, scrotal scanning has allowed a precise evaluation of the testicular perfusion and thus refined the indications for operation. Using scrotal scanning in a series of 18 patients with possible testicular torsion a correct assessment of testicular perfusion was made in every patient. In only two patients did the interpretation differ from the ultimate clinical impression. In one, the torsion had relieved itself before the scan was performed and at operation the testis had adequate perfusion. In the second, clinically suspected epididymitis was not confirmed. Because of the ease and rapidity with which the test may be done in children more testes should be salvaged with fewer negative explorations.