Fig. 4.

Redundant spermatic cord and enlarged epididymal-cord complex in the setting of preserved testicular flow. a Power Doppler US image in a 15-year-old boy who presented with acute right testicular pain shows an avascular pseudomass (arrows) along the superior aspect of the testis. b Scrotal color Doppler sonography shows preserved and increased testicular flow from manual detorsion but there is a bunched up cord as seen in Fig 4a, forming an enlarged epididymal-cord complex or extratesticular pseudomass. This suggests that the cord was tangled with and inseparable from the epididymis, with the point of twist forming the torsion knot. c Gray-scale US image at the level of the external inguinal ring in a 12-year-old boy with 24 h of acute left testicular pain shows a twisted redundant cord (arrow) in the lower inguinal canal (identified retrospectively) with a small surrounding hydrocele. d Color and pulsed wave Doppler US in the same boy as in (c) shows preserved left testicular flow. Because of the long duration of pain, which had begun to improve at the time of exam, and presence of intratesticular flow, he was given a diagnosis of epididymitis. He returned a week later with an infarcted left testis that showed ultrasound findings of late torsion. This example reiterates that duration of pain and presence of intratesticular flow should not deter one from looking for the twisted cord because the latter can clinch the diagnosis