Clinical Presentation

A 12-year-old boy with acute scrotal pain and vomiting.

(A–C) Transverse gray-scale and Doppler images of both testes demonstrate an enlarged, heterogeneously hypoechoic left testis with no internal blood flow (arrows).

Differential Diagnosis

• Testicular torsion: The combination of an enlarged, heterogeneously hypoechoic testis and no demonstrable internal color Doppler signal is essentially diagnostic of testicular torsion.

• Epididymo-orchitis: