Pitfalls & Limitations

 

• PoCUS can be used to rule IN TT, but should not be used to rule OUT in cases with moderate to high pretest probability
• Partial TT may have preserved color doppler flow. It should be decreased when compared to the contralateral testicle.
• Torsion-detorsion may have either reduced or increased signal (hyperemia) depending on the stage of torsion-detorsion, which can mimic orchitis therefore it is imperative to interpret increased perfusion in the clinical context

 

Due to these limitations, if a patient presents with a high TWIST score and a strong history and physical exam suggestive of torsion, but the ultrasound is inconclusive or normal, maintain a high index of suspicion. Consider arranging a repeat scan in the morning or calling in the sonographer if clinically indicated.