Scrotal U/S-infection

Another pearl from Dr. Gordon regarding scanning the testes:

When one testicle shows no flow or much reduced flow on the painful side, torsion is likely.

In this patient the presentation was not as acute as expected of torsion. Scrotal U/S showed increased flow on the painful side and the painful testicle was also larger than the other one. The urine sediment also suggested infection.

If you see a patient where the pain gets dramatically better and the affected testicle  shows somewhat more flow than the painless side, you might suspect a de-torsion, so some interpretation is required. You would expect that epididymo-orchitis would not get dramatically better.

This proves that ultrasound cannot replace clinical thought.  POCUS generates data points but it’s crucial to fit them together with the rest of the examination.