Most often, neonatal testicular torsion is seen right away, at birth. As part of a baby’s first exam, the testicles will be examined. A twisted testicle will not move freely in the scrotum. Or, if one testicle is missing, there can be two reasons:
- It has not dropped down into the scrotum, or
- It twisted before birth and shrunk in size.
Sometimes the testicles change in color or size during the first weeks of life. If the parent or pediatrician sees a firm, swollen or discolored scrotum an alarm should go off. With these signs, the baby should be checked as soon as possible. Other causes of a firm and/or enlarged scrotum include tumors. But, tumors are very rare in this age group.
Most often, a baby born with a firm, red testicle means that it has died from lack of blood flow.
Less often, changes in the testicle may be noticed before it dies. Then treatment may save it.
A nuclear scan or an ultrasound might be done. They can show a lack of blood flow and other signs for diagnosis. Still, these tests may not show enough detail, so they are not always used. A simple physical exam is all that may be used for diagnosis.