Testicular Ultrasound Pearls

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October 21, 2015 by dailybolusoflr

By: Casey Wilson , MD

On behalf of the Ultrasound FAST


  • Keep patient supine and comfortable (analgesia is key!)
  • Place towel underneath scrotum to immobilize and elevate
  • Use high frequency (6-14 MHz) linear probe
  • Generous amount of warmed (if possible) gel to prevent cremasteric reflex
  • Start with unaffected side
  • Obtain transverse and longitudinal views
  • Normal appearance seen in Figure 1


Normal Testes

  • Have a homogenous echogenicity (~ liver)
  • Wall thickness 2-8 mm
  • Normal size ~ 5 x 3 x 2 cm
  • Obtain the “Spectacle View”  – seen in Figure 2
Testicular Torsion

  • Key to diagnosis is a difference in flow
  • Apply color flow when you obtain the “spectacle view”
  • Takes at least four hours to appear hypo-echoic and edematous
  • When you see a flow differential, it’s important to keep in mind which side is hurting!  If the affected side has decreased flow, think torsion.  If the affected side has increased flow, think epididymitis.
  • If the patient’s right testes is painful in the image below (Figure 3), you better be calling urology!

Color Duplex Doppler

  • Color Duplex Doppler is 96-100% sensitive and 84-95% specific for diagnosing testicular torsion.  
  • A negative ultrasound is highly predictive of the ABSENCE of torsion at the time of exam.  
  • Place the probe transversely at the mediastinum testis to assess vascular integrity
  • The image below (Figure 4) demonstrates normal arterial flow.


  1. Adhikari, S.  Small Parts: Testicular Ultrasound.  www.Sonoguide.com
  2. Blaivas M, Sierzenski P, Lambert M. Emergency evaluation of patients presenting with acute scrotum using bedside ultrasonography. Acad Emerg Med. 2001; 8(1):90-3. 
  3. Cassar S, Bhatt S, Paltiel H, et al. Role of spectral Doppler sonography in the evaluation of partial testicular torsion. J Ultrasound Med. 2008;27(11):1629-38

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