ULTRASONOGRAPHIC FINDINGS OF EPIDIDYMAL TORSION IN ADULTS-A RARE CAUSE OF ACUTE SCROTUM/ULTRAZVUCNI NALAZ TORZIJE EPIDIDIMISA KOD ODRASLIH - REDAK UZROK AKUTNOG SKROTUMA

Introduction. Epididymal torsion is a rare cause of acute scrotum. Only a few cases have been described in the literature, and preoperative ultrasound diagnosis was done only in two cases. So far, according to our data, cases of epididymal torsion in adults have not previously been reported in the literature. Case Report. We report the case of a 39-year-old man, who was admitted to the hospital for pain in the left hemiscrotum lasting for three days. The physical examination revealed a swelling limited to the left hemiscrotum, so the patient was referred for an ultrasound examination with the diagnosis of epididymitis. The ultrasonography showed that the left epididymis was significantly enlarged in the head area with and heterogeneous structure of the parenchyma on a grayscale, without a significant Color Doppler signal. At the level of the neck and the body of the epididymis, there was a "whirlpool sign" with a reactive hydrocele and edema of the left scrotum soft tissue that was highly suspicious for torsion of the epididymis. The patient underwent emergency surgery and epididymal torsion of about 540 degrees was confirmed intraoperatively. Conclusion. The torsion of the epididymis should be kept in mind in the differential diagnosis of acute scrotal pain in adults. Key words: Ultrasonography; Ultrasonography, Doppler, Color; Scrotum; Epididymis; Torsion Abnormality; Adult; Acute Pain; Signs and Symptoms; Genital Diseases, Male Uvod. Torzija epididimisa je vrlo redak uzrok akutnog skrotuma. Samo je nekoliko slucajeva torzije epididimisa opisano u literaturi, a samo dva slucaja imaju preoperativnu ultrazvucnu dijagnozu. Do sada, u literaturi prema nasim podacima nije opisana torzija epididimisa kod odraslih. Prikaz slucaja. Predstavljamo slucaj 39-godisnjeg muskarca koji je primljen u bolnicu zbog bolova u levom hemiskrotumu, koji traju tri dana. Na fizikalnom pregledu otkriven je otok ogranicen na levi hemiskrotum, pa je pacijent upucen na ultrazvucni pregled sa dijagnozom epididimitisa. Ultrasonografski levi epididimis je znacajno uvecan u predelu glave i heterogene strukture parenhima na sivoj skali, bez signifikantnog kolor dopler signala. Na prelasku vrata u telo epididimisa videli smo znak ,,vrtloga" sa reaktivnom hidrokelom i edemom mekog tkiva levog skrotuma, sto je bilo visoko suspektno za torziju epididimisa. Pacijent je odmah operisan i intraoperativno je potvrdeno postojanje torzije epididimisa za oko 540 stepeni. Zakljucak. Torziju epididimi