Boggy pseudomass sonographic sign for testicular torsion
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CLASSICS IN ABDOMINAL RADIOLOGY
Boggy pseudomass sonographic sign for testicular torsion Hassan Aboughalia1 · Elizabeth R. Tang1 · Ramesh S. Iyer1 Received: 5 August 2020 / Revised: 13 September 2020 / Accepted: 21 September 2020 © Springer Science+Business Media, LLC, part of Springer Nature 2020
“Boggy” is a term that describes wet, spongy ground, typically with poor drainage (Fig. 1). In the scrotum, a “boggy pseudomass” (Fig. 2) is an indicator of testicular torsion [1, 2]. Recognized for decades now [3, 4] and first coined as a phrase in 2013 [2], this sign may be more frequently seen in
Fig. 1 Photograph of a bog. Note the appearance of the poorly draining areas of dark pooling water in the bogs. Public domain image downloaded from Pikist Sept 7th, 2020. https://www.pikist.com/freephoto-vwyux
testicular torsion than the better-known “whirlpool” sign of a twisted spermatic cord [1, 2]. A “boggy pseudomass” is an * Hassan Aboughalia [email protected]
extratesticular, mass-like structure, consisting of redundant or enlarged spermatic cord extending down to epididymis, which itself can also become swollen and difficult to separate from the adjacent cord (Fig. 2) [2, 3]. The underlying pathophysiology often results from a “bell-clapper” deformity where excessive tunica albuginea coverage interferes with testicular attachment and allowing the cord to twist [1]. The consequent testicular torsion most commonly manifests in, but is not limited to, the adolescent population. Absent epididymal or testicular color Doppler vascularity from complete torsion easily differentiates the vast majority of cases with “boggy pseudomass” from nonsurgical conditions, like reactive inflammation of the epididymis or infectious epididymitis [1, 3, 4]. However, in intermittent testicular torsion, normal or hyperemic epididymal or testicular color Doppler vascularity can be seen, which may mimic the nonsurgical entities and introduce diagnostic confusion [5]. Attention to the spermatic cord is necessary to help clarify such cases. Munden et al. found certain sonographic abnormalities of the cord (thickened “boggy” or swirling “whirlpool” appearance; “pseudomass” just below a cord twist) to be statistically significant to diagnosis of intermittent torsion; occasionally “boggy” cord was the only abnormal grayscale feature [2]. Therefore, sonographic scrutiny of the spermatic cord for these features, including transverse and longitudinal real-time or cine clip imaging for cord twist, or cine clips is particularly crucial. In summary, recognition of the "boggy pseudomass" sign avoids misdiagnosis of testicular torsion as nonsurgical infectious or inflammatory conditions, or potentially as extratesticular mass or hematoma, which might otherwise delay the requisite timely salvage of the testes [2].
Elizabeth R. Tang [email protected] Ramesh S. Iyer [email protected] 1
Radiology Department, Seattle Children’s Hospital, University of Washington School of Medicine, Seattle, WA 98105, USA
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