Left testicular torsion

A 6-week-old male infant presented with a reddish, painful, and swollen scrotum of 2 days’ duration. What is the diagnosis?

Dx: Left testicular torsion

Explanation :

Bilateral hydroceles are present, and the left scrotum is red and swollen. The flashlight test reveals transillumination of a right-sided hydrocele and opacity of the left scrotum. The most likely diagnosis of testicular torsion was confirmed with Doppler ultrasonography.

Ultrasonography revealed a 1.0-cm3 testis on the right side and a 1.45-cm3 testis on the left with associated scrotal edema. Doppler studies revealed obstruction of blood flow to the left testicle. These findings confirmed the diagnosis of left-sided testicular torsion. Surgical exploration revealed the left testicle to be necrotic; unilateral orchidectomy was performed. The infant was discharged 1 day after surgery. The postoperative course was uneventful, and the hydroceles had not recurred at 1-year follow-up. Congenital hydroceles are common, and most resolve spontaneously within a year; testicular torsion is an uncommon but serious complication.