Fig. 7.

Epididymal enlargement without hyperemia. a Color Doppler longitudinal US image of the epididymal head and testis in a 12-year-old boy who woke with acute left testicular pain and nausea. Image shows an enlarged epididymal head (H) with a swollen lobular appearance and lack of intrinsic color flow. The intratesticular flow was decreased. He underwent emergent bilateral orchiopexy for a complete left torsion, and a bell clapper deformity was appreciated. Even though the epididymis was enlarged, it was avascular, thus ruling out epididymitis. b Gray-scale longitudinal US image of the epididymal-cord complex in a 7-year-old boy with 3 days of intermittent left testicular pain shows an edematous epididymal head (H) with a tangled echogenic cord (C) while the epididymal tail (T) appears relatively uninvolved. His left testis, however, showed somewhat decreased flow and he was diagnosed with partial torsion. A 360° twist was found during orchiopexy along with bilateral classic bell clapper deformity