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The Sonographic Twinkling Artifact in Testicular Calcification

Department of Radiology, King’s College Hospital, London, England.

Address correspondence to Paul S. Sidhu, FRCR, Department of Radiology, King’s College Hospital, Denmark Hill, London SE5 9RS, England. E-mail: paul.sidhu{at}kch.nhs.uk

Objective. The twinkling artifact is a color Doppler phenomenon that appears as a rapidly fluctuating red and blue Doppler signal behind a strongly reflecting medium, manifesting as a color signal but without real flow behind the structures. To the untrained eye, the twinkling artifact may lead to the misdiagnosis of vascular flow within a structure. Our objective was to show the occurrence of the twinkling artifact in the testis. Methods. Two patients with calcification in the testis were examined with standard settings on 2 different sonography machines to show this artifact. Results. Calcification in the tunica albuginea and intratesticular macrocalcification both showed this artifact. Conclusions. We report the presence of the twinkling artifact in 2 cases of testicular calcification, which shows that this phenomenon can occur in the testis.

Key Words: color Doppler sonography • testis • twinkling artifact