TESTICULAR TORSION IN A NEONATE

Purpose: This poster will present a rare case of a congenital testicular teratoma in a 4 week old male who presented to Cook Children's Emergency Department with a testicular torsion. We will discuss the imaging studies of choice and management when investigating scrotal masses and testicular swelling. Methods: Retrospective review of one patient's medical records, including imaging studies and pathology results, from date of admission to discharge as well as a review of pertinent literature. A transcrotal surgical approach was used rather than an inguinal approach because the primary concern was torsion at the time. During the operation, the surgeon noted the testicle to be grossly torsed, uniformly gray and hardened. The appearance was consistent with a tumor and so the testicle was resected and sent for pathology. Results: In respect to diagnosis of testicular masses, literature favors radiologic imaging like CT scan. When testicular torsion is suspected, however, the imaging studies of choice are ultrasound with Doppler. Conclusions: The appropriate use of imaging modalities is pivotal when approaching testicular changes in the perinatal period. When Doppler ultrasound suggests ischemic damage is eminent, it is imperative to prioritize saving a testicle over obtaining an exact diagnosis of the cause. Neonatal teratomas are rare, for the most part clinically benign and usually diagnosed at birth. In this case, however, the teratoma presented as a testicular torsion which required emergent surgery before a sure diagnosis of the cause could be made. Further studies need to be done to determine the best approach to testicular torsions in the neonatal period.