Testicular torsion in neonates: importance of power Doppler imaging.

Power Doppler sonography has been shown to have greater sensitivity to blood flow than conventional color Doppler sonography.Whether this increased sensitivity provides clinically relevant information for a diagnosis of neonatal testicular torsion has been questioned.We present the case of a newborn infant who was thought to have bilateral testicular torsion and infarction based on gray scale and color Doppler ultrasonographic findings.Power Doppler imaging and surgery proved one testicle to be viable.This case both demonstrates the value of power Doppler sonography in detecting normally low flow in the neonatal testicle and shows that the finding of hypoechoic testicles may not necessarily mean infarction.Duplex sonography and color Doppler ultrasonography play key roles in the diagnosis of testicular torsion in adolescents and adults. 1 In neonates, however, since testicular blood flow normally is low and often is below the sensitivity of conventional color Doppler sonography, a definitive sonographic diagnosis can be more difficult than in adolescents.2 The clinical usefulness of power Doppler sonography in such cases is being evaluated.We present a case of testicular torsion in a neonate that appeared to show bilateral infarction on gray scale and conventional color Doppler sonographic images.Only after power Doppler imaging was the diagnosis of unilateral testicular torsion and a salvageable second testicle made. CASE REPORTThe patient was a full term male infant delivered by cesarean section because of fetal distress.The pregnancy was complicated by breech presentation and preeclampsia.After delivery, it was noted that the infant had an enlarged, indurated scrotum that did not transilluminate.Physical examination revealed hard testicles bilaterally, suggesting testicular infarction.Bilateral orchiectomy, with the prospect of raising the child as a girl, was considered.Subsequent gray scale scrotal ultrasonography revealed bilaterally hypoechoic testicles with relatively echogenic peripheries (Fig. 1).Conventional color Doppler imaging demonstrated no central flow in either testicle.These findings were thought to be suggestive of bilateral testicular torsion and infarction of unknown age.Power Doppler imaging of the testicles, however, revealed central flow on the right (Fig. 2) but only peripheral flow on the left (Fig. 3).