Tunde developed right testicular pain and swelling over two days. The critical question was: torsion (a surgical emergency) or epididymo-orchitis (an infection)? A scrotal Doppler scan at Mascot Healthcare answered within minutes — blood flow was normal, torsion excluded, infection confirmed and treated.
Student, Mushin. Presented with 2-day history of right testicular pain and swelling — gradual onset, worsening. Right epididymis markedly tender and swollen on examination. No history of trauma. Temperature 37.9 °C. Sexually active. Referred urgently for scrotal Doppler ultrasound to exclude testicular torsion.
Scrotal Ultrasound ScanTunde had noticed the right testicular discomfort on a Tuesday morning. He assumed he had "twisted something" during football the previous day. By Wednesday evening, it was swollen, warm, and the pain had moved from dull to sharp. He told his roommate, who told him to go to a clinic immediately.
At Mascot Healthcare, the doctor examined the right scrotum: the epididymis was markedly swollen and exquisitely tender — more tender than the testis itself. The cremasteric reflex was present (absent in torsion). Temperature was 37.9 °C. The clinical picture favoured epididymo-orchitis over torsion — but clinical features alone are insufficient to exclude torsion safely. A scrotal Doppler scan was ordered urgently.
"We need to see blood flowing inside the testis," the doctor explained to Tunde. "If blood flow is absent or reduced compared to the other side, that would mean the cord is twisted and you would need surgery tonight. If blood flow is normal or increased — which happens with infection — it confirms the infection diagnosis." The scan took 8 minutes.
Testicular torsion — twisting of the spermatic cord — cuts off blood supply to the testis and causes permanent damage within 6 hours. It is a surgical emergency. Epididymo-orchitis — infection of the epididymis — presents identically. A scrotal Doppler ultrasound distinguishes the two in minutes, directing the correct management: surgery or antibiotics.
Right-sided testicular and epididymal pain building over 48 hours — the presentation overlaps completely between torsion and epididymo-orchitis.
Testicular torsion is most common in adolescents and young men aged 12–25 — making urgent exclusion essential at this age.
Testicular salvage rates after torsion: > 90% if operated within 6 hours; < 10% after 24 hours. Speed is critical.
Recent sexual activity raises the probability of epididymo-orchitis from STI (chlamydia, gonorrhoea) — supporting the need for co-infection screen alongside the scan.
Low-grade fever — more consistent with infection than torsion, but not sufficient to exclude torsion without imaging.
The doctor was direct with Tunde: if this was torsion and was not surgically corrected within the next few hours, he could lose the testis permanently. That sentence changed the room. Tunde, who had been quietly embarrassed about the entire situation, sat very still.
The Doppler probe was placed on the right scrotum. The colour flow image appeared — red and blue signals filling the right testis, matching and then exceeding the left. "There's your blood flow," the sonographer said. "Good flow — no torsion." Tunde exhaled. His roommate, who had insisted on coming with him, put his face in his hands with relief.
Right testis: normal size and echogenicity — 4.1 × 2.8 cm, homogeneous texture, no focal lesions. Right epididymis: markedly enlarged and hypoechoic — head measures 1.9 cm (normal < 1.0 cm). Colour Doppler: increased vascularity throughout the right testis and epididymis compared to the left — the characteristic finding of epididymo-orchitis (hyperaemia from infection). Absent end-diastolic flow: no. Normal venous return confirmed.
Left testis: normal size, texture, and Doppler flow. No hydrocele or varicocele. No scrotal skin thickening.
Conclusion: right epididymo-orchitis — torsion excluded. STI co-infection screen requested: chlamydia NAAT positive. Treatment: a 14-day course of oral medication plus a single injection to cover gonorrhoea; scrotal support; pain relief; partner notification.
Right epididymo-orchitis: enlarged hypoechoic epididymis, increased Doppler flow. Torsion excluded (normal intratesticular blood flow). Left testis: normal.
A 14-day course of oral medication; a single injection to cover gonorrhoea; scrotal support; a painkiller; chlamydia contact tracing; repeat review at 6 weeks.
At 6 weeks: pain fully resolved, epididymis soft and non-tender. Repeat scrotal ultrasound: right epididymis normal size. Chlamydia repeat NAAT: negative.
Complete resolution of epididymo-orchitis at 6 weeks. Torsion was excluded by the scan — preserving the testis. Chlamydia treated and partner notified.
Testicular pain that persists for more than a few hours — especially with swelling — is a urological emergency until torsion is excluded. A scrotal Doppler ultrasound takes 10 minutes and gives a definitive answer that clinical examination cannot.
Epididymo-orchitis in a young sexually active man is often caused by chlamydia or gonorrhoea. A co-infection screen is essential alongside the scan — treating the infection without identifying the cause risks re-infection and partner transmission.
Testicular pain + swelling = scan the same day. Torsion gives you a 6-hour window. A Doppler ultrasound takes 10 minutes and tells you whether you need surgery or antibiotics.
Book online or via WhatsApp — same-day scan results, expert sonography, transparent pricing.