Is imaging always required before surgical management in suspected torsion?

• A. Yes, always before surgery
• B. No, not if there is high clinical suspicion
• C. Only in pediatric patients
• D. Only if ultrasound is available

Answer: (B)

The key idea here is that torsion is an emergency where time matters for saving the affected testicle. If the clinical picture strongly suggests torsion—sudden severe scrotal pain, high-riding testis, loss of cremasteric reflex, and supportive history—delaying for imaging can allow the torsion to progress and reduce salvage rates. Therefore, in that situation you proceed to urgent surgical exploration without waiting for imaging.

Imaging, especially ultrasound with Doppler, is useful when the diagnosis isn’t clear or to confirm and plan management, but it should not delay or replace immediate exploration when suspicion is high. Early torsion can even have variable Doppler findings, and reliance on imaging can miss or delay the diagnosis. So the best answer reflects that imaging is not required before surgery if there is high clinical suspicion.