The nuclear isotope testis scan you ordered appears at the right. The scrotum shows up as white dots. The black line in the middle of the scrotum is actually a lead rod placed to demonstrate where the median raphé lies. The entire left scrotum shows uptake of the isotope (it is uniformly white). The right side of the scrotum has a dark gray area. This represents a testis with impaired perfusion (it does not take up the isotope).

Now you have a boy with an ischemic testis from spermatic cord torsion in the nuclear medicine department. What will you do next?

The picture on the right shows the results of a scrotal exploration in a young boy with a history of scrotal pain for several hours. He had a delayed diagnosis of spermatic cord torsion. The testis is completely necrotic. Untwisting the testis did not improve the perfusion. It was removed. Never let this happen to your patient.

For heaven's sake, take this boy to surgery!

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©David A. Hatch, M.D., 1996