Case Author(s): J. Philip Moyers, M.D. and Henry D. Royal, M.D. , 10/2/95 . Rating: #D1, #Q3

Diagnosis: Subacute testicular torsion

Brief history:

Testicular pain


Anterior flow images of the scrotum

View main image(ts) in a separate image viewer

View second image(ts). Immediate static images of the scrotum

Full history/Diagnosis is available below

Diagnosis: Subacute testicular torsion

Full history:

20 year old man who developed sudden left testicular pain three days prior to the scan. The pain has persisted over the three days, becoming more diffuse and dull in nature. He has noted left testicular swelling. The right testis is normal.


15.2 mCi Tc-99m pertechnetate i.v.


The radionuclide angiogram demonstrates increased blood flow in the region surrouding the left testicle. The left testicle itself is decreased in activity. The immediate static images demonstrate no significant radiopharmaceutical activity within the left testis although the tissue surrounding the left testis demonstrates persistently increased activity.


Scrotal imaging can be a useful adjunct in the diagnosis of testicular torsion. At our institution, if testicular torsion is strongly suspected, the patient usually procedes to the operating room without a diagnostic imaging study in order not to delay diagnosis. Patients who are evaluated using scrotal scintigraphy included those with a low pre-test probability for testicular torsion in whom the clinicians want to exclude testicular torsion and in those with a late presentation or a confusing clinical and physical findings. Scrotal imaging can be valuable in these cases. The diagnosis of torsion include acute and subacute torsion. Acute torsion is defined as less than 24 hours. Testicular viability decreases markedly after 24 hours and is best preserved if the history of torsion is less than six hours. In this case, a bullšs-eye appearance of an area of decreased activity in the mid portion of the left scrotum with a rim of increased activity suggests subacute torsion. However, this appearance is not pathognomonic and may be demonstrated with abscess or hematoma. Epididymitis ususally has increased blood flow and diffusely increased activity on the immediate static images.

References: Mettler FA. Essentials of Nuclear Medicine Imaging. 1991, 3rd edition.


The patient was referred to the operating room. In the operating room, a 360 degree torsion of the vascular supply to the left testicle and an infarcted left testis was demonstrated. The left testicle was removed. A right-sided orchiopexy was performed.

Differential Diagnosis List

Abscess, hematoma, infected hydrocele

ACR Codes and Keywords:

References and General Discussion of Testicular Scintigraphy (Anatomic field:Genitourinary System, Category:Organ specific)

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Case number: ts002

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