Ultrasound whirlpool sign in intermittent testicular torsion: Presentation of two cases

Abstract

Case description: The two cases were characterized by multiple episodes of very intense pain that resolved spontaneously. Testicular ultrasound was carried out in both cases, during an acute episode of pain. The Whirlpool sign was identified, together with vascular compromise of the testis, suggesting intermittent testicular torsion that required surgical treatment.

Relevance: The aim of our report was to describe how intermittent testicular torsion is an uncommon pathology that should be suspected in young patients presenting with episodes of intense pain. Diagnostic ultrasound should be performed during an episode of pain.

Clinical implications: Due to vascular compromise in the testis, opportune diagnosis is important. It begins with diagnostic suspicion that is supported by the patient’s clinical manifestations and proceeds to early bilateral testicular fixation, preventing necrosis of the testis.

Conclusions: Intermittent testicular torsion is rare and difficult to diagnose. Prompt identification of the whirlpool sign during an acute episode of pain is essential for making the diagnosis and preventing the loss of the testis, which could result from underestimating subsequent episodes of pain.