An adolescent boy presented with right-sided abdominal pain followed by right-sided hemiscrotal pain and swelling. Ultrasound examination shows a twisted right spermatic cord which is a direct sign of the torsion. The indirect signs are present in the testis including an enlarged testis without parenchymal flow. There is a loss of normal echopattern of the testis which favors infarction.

Surgery undertaken within 2 hours and the right testis was not viable.

Photo courtesy: Dr. Niraj Patel, Dr. Vivek Patel.