Triorchidism with Torsion
A 72-year-old man presented with vague pain in the lower abdomen and scrotum. There was no history of trauma and he stated that the pain was severe in nature and had been present for a short time. He was married and had three children. Physical examination revealed swelling of scrotum on the left side. There were no features to suggest inguinal hernia. He was referred to the radiology department for evaluation of pain.\nUltrasonography of abdomen was normal. Gray scale and color Doppler sonography of right hemiscrotum revealed a normal testicle with homogenous texture, measuring about 3.8 × 3 cm. Normal intratesticular flow was noted. Epididymis was normal in size and echotexture. Minimal hydrocele was noted []. Left hemiscrotum revealed two testicles The lower testis showed homogenous echotexture, measuring 3.7 × 3 cm, with normal intratesticular flow. The upper testis measured 3.2 × 2.4 cm and showed homogenous hypoechogenicity with no detectable intratesticular flow compatible with ischemia [Figures and ]. Epididymis was single and appeared normal. Minimal hydrocele was noted.\nMagnetic resonance imaging (MRI) examination was done, which showed normal T 1 and T 2 images of right testis and lower testis of left hemiscrotum []. The upper testis of left hemiscrotum showed increase signal intensity on T1 and decreased signal intensity on T2 images, suggestive of torsion and hemorrhagic necrosis []. Minimal hydrocele was noted in both hemiscrota.