Fig. 3.

Intermittent torsion in a 17-year-old boy who presented with 5 h of acute right testicular pain after a game of football. He had experienced 6–7 similar episodes in the last 2 years where the pain had spontaneously resolved. Cremasteric reflex was absent on the right. a Gray-scale transverse US image of the right testis shows a redundant spermatic cord (arrow) occupying the medial half of the scrotal sac, with a mildly edematous epididymis (E) adjacent to it. The echogenic mediastinum testis faced medially instead of posterolaterally, which was concerning for altered testicular lie. b Color Doppler longitudinal image of the right scrotum shows excess and tortuous spermatic cord bunched up in the scrotal sac superior to the testis and formation of pseudomass, suggesting torsion of the spermatic cord. Note that this extratesticular pseudomass is not hyperemic and should not be confused with epididymitis. Orchiopexy was recommended; however the family chose to wait because his pain improved. Elective orchiopexy was performed 7 months later and bilateral bell clapper anomaly was noted; he was diagnosed with intermittent torsion