Testicular Torsion in Infants

Causes and Types

Testicular torsion in infants is primarily caused by an extravaginal twisting of the spermatic cord that often occurs prenatally or perinatally, compromising blood flow to and from the testicle 1
Perinatal testicular torsion is uncommon, accounting for approximately 10% of testicular torsion cases in children 2
Testicular torsion has a bimodal distribution, occurring more frequently in neonates and postpubertal boys than in adults, although it can occur at any age 1

The "whirlpool sign" (spiral twist of the spermatic cord) is the most specific ultrasound sign of torsion 3

Immediate surgical intervention is recommended when testicular torsion is suspected in an infant 4
The salvage rate for the affected testicle depends on the degree of torsion and duration of ischemia 3
Surgical exploration within 6-8 hours of symptom onset is essential to prevent testicular loss in cases of acute torsion 1, 4

Ultrasound is the primary diagnostic tool for both perinatal and prenatal testicular torsion, with grayscale ultrasound findings showing heterogeneous echotexture and calcifications or cystic areas in prenatal torsion, and an enlarged, hypoechoic or heterogeneous testicle with the "whirlpool sign" in perinatal torsion, according to the American College of Radiology 5

The American Academy of Pediatrics recommends immediate surgical exploration for perinatal torsion occurring after birth to attempt testicular salvage, with salvage possible if diagnosed and treated within 6-8 hours of symptom onset 5