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Cold Room Test / Ice Pack Test in Scrotal Ultrasound
Purpose:
The Cold Room Test or Ice Pack Test is a simple, non-invasive procedure used to differentiate between:
- Retractile Testis (normal cremasteric reflex, no true undescended testis)
- Undescended Testis (Cryptorchidism)
This test helps assess the cremasteric reflex, which can cause the testis to retract into the inguinal canal, making it difficult to locate during an ultrasound exam.
Procedure:
Baseline Ultrasound Examination
- Perform an initial scrotal and inguinal ultrasound to locate the testis.
- Note the position, echotexture, and vascularity of the testis.
Cold Room or Ice Pack Stimulation
- The patient is placed in a cold environment (air-conditioned room) for a few minutes OR
- A cold pack (wrapped in a towel) is applied to the inner thigh or scrotum for about 1–2 minutes.
- Cold exposure induces scrotal contraction but inhibits the cremasteric reflex, allowing a retractile testis to descend.
Post-Test Ultrasound Evaluation
- The testis is re-examined to check if it has moved back into the scrotum.
- If the testis descends into the scrotum → Retractile Testis (Benign, no surgery needed).
- If the testis remains undescended → True Undescended Testis (Cryptorchidism, may need surgery).
Interpretation of Results:
➤ Retractile Testis:
- The testis reappears in the scrotum after cold stimulation.
- Considered normal, just a hyperactive cremasteric reflex.
- No treatment needed, but follow-up in children until puberty.
❌ Undescended Testis (Cryptorchidism):
- The testis remains in the inguinal canal or abdomen, even after the cold stimulus.
- Indicates true cryptorchidism, which may require surgical correction (orchidopexy).
Clinical Use Cases:
✔ Differentiating retractile testis vs. true undescended testis in pediatric patients.
✔ Used when the testis is intermittently non-palpable.
✔ Helps in surgical decision-making for cryptorchidism.
