For suspected testicular torsion, which imaging modality is the diagnostic imaging of choice to confirm the diagnosis?

• A. Transillumination
• B. Doppler Ultrasound
• C. Urine Culture
• D. Serum HCG Levels

Answer: (B)

Color Doppler ultrasound is the imaging modality of choice for suspected testicular torsion because it directly assesses testicular perfusion. Twisting of the spermatic cord reduces arterial inflow and venous drainage, so the key diagnostic feature is decreased or absent intratesticular blood flow on Doppler imaging. This helps distinguish torsion from inflammatory conditions like epididymo-orchitis, which usually shows normal or increased flow due to hyperemia. On grayscale ultrasound you may see an enlarged, hypoechoic, or edematous testis and possible scrotal fluid, but the critical clue is the perfusion pattern. If suspicion remains high despite a nondiagnostic study, urgent surgical exploration should not be delayed, as time is crucial for testicular salvage. Transillumination offers limited information and cannot reliably diagnose torsion; urine culture and serum HCG levels do not address this acute emergency.