scholarly journals Acute scrotum: differential diagnosis and treatment

2018 ◽  
Vol 97 (3) ◽  
pp. 278-282
Author(s):  
João Arthur Brunhara Alves Barbosa ◽  
Marco Antonio Arap
Keyword(s):  
Blood Flow ◽  
Differential Diagnosis ◽  
Testicular Torsion ◽  
Color Doppler ◽  
Testicular Tumor ◽  
Signs And Symptoms ◽  
Clinical Syndrome ◽  
Acute Scrotum ◽  
Viral Etiology ◽  
Scrotal Pain

Acute scrotum (AS) is a clinical syndrome characterized by scrotal pain of acute onset, often accompanied by scrotal swelling and other local and systemic signs and symptoms. It may be the initial presentation of several diseases including testicular torsion, orchitis, epididymitis, hydatid torsion, strangulated hernia and, less frequently, scrotal hematoma and testicular tumor. In the setting of emergency services, physicians should be extremely careful with the possibility of testicular torsion. This condition consists in the torsion of the spermatic cord, leading to an interruption of the testicular blood flow, with ischemia and ultimately necrosis. It is associated with acute severe pain, nausea, absence of the cremasteric reflex, and a high-riding testis. Physical examination may help diagnosis. However, a color Doppler ultrasound of the scrotum is usually required for a definitive diagnosis. Ultrasound will reveal a reduction or no blood flow to the affected testis; surgical treatment is mandatory and should be performed as early as possible. A differential diagnosis is orchiepididymitis. It may be of viral etiology in early childhood and bacterial after the beginning of sexual activity. The most specific sign associated with this condition is the relief of pain after elevation of the testis, known as Prehn’s sign. Treatment for bacterial cases requires antibiotics, while cases of viral etiology require only symptomatics. Hydatid torsion, including torsion of appendix testicularis and appendix epididymis may mimic testicular torsion but on ultrasound, blood flow is preserved, and a twisted appendix is often seen. Treatment for this condition consists only in symptomatic control. Testicular torsion should be treated as early as possible, since a delay of 6 hours may result in organ loss. Surgery consists of bilateral orchiopexy in case of a viable testicle and orchiectomy of a necrotic organ, always with fixation of the contralateral testicle.

scholarly journals The Diagnostic Accuracy of Testicular Torsion by Doctors on Duty Using Sonographic Evaluation with Color Doppler

2020 ◽  
Vol 14 (5) ◽  
pp. 155798832095300
Author(s):  
Akinori Nakayama ◽  
Hisamitsu Ide ◽  
Akiyoshi Osaka ◽  
Yasuyuki Inoue ◽  
Yukihito Shimomura ◽  
...  
Keyword(s):  
Blood Flow ◽  
Diagnostic Accuracy ◽  
Testicular Torsion ◽  
Color Doppler ◽  
Ultrasonic Transducer ◽  
Color Doppler Ultrasound ◽  
Medical Emergency ◽  
Acute Scrotum ◽  
Scrotal Pain ◽  
Testicular Blood Flow

As testicular torsion is a medical emergency, it requires quick diagnosis and treatment. Color Doppler ultrasound (CDUS) is useful for the diagnosis of testicular torsion. An accurate diagnosis can be difficult when CDUS indicates the preservation of blood flow in the testis. We examined the accuracy of testicular torsion diagnosis in patients with acute scrotum made by doctors on duty using CDUS. The subjects included 26 patients who visited our department between January 2016 and June 2018 presenting with acute scrotal pain. Patients were placed into one of three groups based on testicular blood flow evaluated by CDUS. The first group had no testicular blood flow, the second had diminished blood flow, and the last group had normal or increased blood flow. Patients were also diagnosed through scrotal exploration. Finally, patients were further divided into two groups identified by CDUS frequency utilized during diagnosis (12 MHz groups and ≤8 MHz groups), and the diagnostic accuracy of the two groups was compared. Characterizing torsion by either the absence of or diminished, testicular blood flow in the CDUS evaluation, the sensitivity and specificity of the CDUS performed by doctors on duty accounted for 69.2% and 53.8%, respectively. No improvement in diagnostic accuracy was evident despite the usage of a 12-MHz ultrasonic transducer. In this study, the sensitivity of CDUS performed by doctors on duty was about 70%, suggesting that scrotal exploration should be performed promptly even if testicular blood flow is observed and testicular torsion is suspected from medical history and body findings.

Reliability of colour Doppler ultrasound in the differential diagnosis of acute scrotum

2011 ◽  
Vol 152 (23) ◽  
pp. 909-912 ◽  
Author(s):  
Laura Sándor ◽  
Tímea Gajda ◽  
Vanda Aranyi ◽  
István Csízy ◽  
Tamás Cserni
Keyword(s):  
Differential Diagnosis ◽  
Doppler Ultrasound ◽  
Predictive Value ◽  
Testicular Torsion ◽  
Color Doppler ◽  
False Negative ◽  
Acute Scrotum ◽  
Colour Doppler ◽  
Colour Doppler Ultrasound ◽  
Operative Notes

Acute scrotum, when testicular torsion is suspected, needs emergency exploration. However, acute scrotum caused by torsion of the Morgagni hydatid and epididymitis can be managed conservatively. Real time colour Doppler ultrasound is becoming a more and more popular tool in the differential diagnosis, however, its reliability is still not widely accepted and exploration is preferred. Material and methods: Case notes of 124 patients treated with acute scrotum during the last 10 years have been reviewed, and the result of physical examination, color Doppler ultrasound, operative notes and clinical outcome were analysed. Results: The final diagnosis was torsion of Morgagni hydatid in 100 cases, furthermore 11 testicular torsion, 8 epididymitis and 10 idiopathic cases were identified. Preoperative colour Doppler ultrasound was done in 45 cases, and exploration was performed in 111 cases. In 38 cases the colour Doppler ultrasound excluded and in 7 cases verified the possibility of testicular torsion. Two false positive and 0 false negative cases were identified. The specificity was 95.0%, sensitivity 100.0%, negative predictive value 100.0%, and positive predictive value 71.4%. Discussion: Colour Doppler ultrasound seems to be a reliable tool in the differential diagnosis of acute scrotum. Its routine use could reduce the number of emergency explorations. Orv. Hetil., 2011, 152, 909–912.

scholarly journals Ultrasonographic findings of epididymal torsion in adults - a rare cause of acute scrotum

2021 ◽  
Vol 74 (1-2) ◽  
pp. 38-40
Author(s):  
Daniela Donat ◽  
Slobodan Torbica ◽  
Sandra Trivunic-Dajko ◽  
Viktor Till
Keyword(s):  
Differential Diagnosis ◽  
Ultrasound Examination ◽  
Color Doppler ◽  
The Body ◽  
Acute Scrotum ◽  
Heterogeneous Structure ◽  
Scrotal Pain ◽  
Acute Scrotal Pain ◽  
Whirlpool Sign ◽  
Head Area

Introduction. Epididymal torsion is a rare cause of acute scrotum. Only a few cases have been described in the literature, and preoperative ultrasound diagnosis was done only in two cases. So far, according to our data, cases of epididymal torsion in adults have not previously been reported in the literature. Case Report. We report the case of a 39-year-old man, who was admitted to the hospital for pain in the left hemiscrotum lasting for three days. The physical examination revealed a swelling limited to the left hemiscrotum, so the patient was referred for an ultrasound examination with the diagnosis of epididymitis. The ultrasonography showed that the left epididymis was significantly enlarged in the head area with and heterogeneous structure of the parenchyma on a grayscale, without a significant Color Doppler signal. At the level of the neck and the body of the epididymis, there was a ?whirlpool sign? with a reactive hydrocele and edema of the left scrotum soft tissue that was highly suspicious for torsion of the epididymis. The patient underwent emergency surgery and epididymal torsion of about 540 degrees was confirmed intraoperatively. Conclusion. The torsion of the epididymis should be kept in mind in the differential diagnosis of acute scrotal pain in adults.

scholarly journals A case of seminoma presented with clinical manifestations of testicular torsion

2017 ◽  
Vol 89 (3) ◽  
pp. 236
Author(s):  
Aytac Sahin ◽  
Caglar Yildirim ◽  
Serkan Akan ◽  
Ozgur Haki Yuksel ◽  
Ahmet Urkmez
Keyword(s):  
Differential Diagnosis ◽  
Physical Examination ◽  
Clinical Picture ◽  
Laboratory Tests ◽  
Testicular Torsion ◽  
Clinical Manifestations ◽  
Testicular Tumor ◽  
Imaging Modalities ◽  
Acute Scrotum ◽  
Testicular Tumors

Testicular tumors rarely manifest themselves with clinical picture of testicular torsion. In this presentation of ours, we reported a 30-year-old patient whose post-orchiectomy histopathology report revealed the presence of seminoma. The patient consulted us with acute scrotum whose physical examination and Doppler ultrasonographic findings showed testicular torsion. Though rarely seen patients, in cases who consulted with acute scrotum, the possibility of testicular tumor should not be discarded. For the establishment of differential diagnosis detailed anamnesis and physical examination findings should be supported with laboratory tests and imaging modalities.

scholarly journals Unusual Cause of Acute Scrotal Pain-Inflammatory Noncommunicating Hydrocele: A Pediatric Case Report

2018 ◽  
Vol 2018 ◽  
pp. 1-4
Author(s):  
Yoshinobu Moritoki ◽  
Kentaro Mizuno ◽  
Taiki Kato ◽  
Takahiro Yasui ◽  
Yutaro Hayashi
Keyword(s):  
Differential Diagnosis ◽  
Emergency Surgery ◽  
Doppler Ultrasonography ◽  
Color Doppler ◽  
Color Doppler Ultrasonography ◽  
Acute Scrotum ◽  
Pediatric Case ◽  
Scrotal Pain ◽  
Acute Scrotal Pain ◽  
General Physicians

The etiology of scrotal pain is clinically classified in terms of the necessity for emergency surgery. Lately, color Doppler ultrasonography has reduced unnecessary surgeries, but there are still some cases that require immediate exploration because of an uncertain diagnosis. Here, we describe the case of a 14-month-old boy, who could not deliver his complaint accurately, presenting with a grumpy mood and a red swollen scrotum. Emergency surgery revealed that the cause was intense inflammation of the hydrocele wall, which typically does not cause acute scrotum. We also reviewed rare etiologies of scrotal pain for general physicians to develop the differential diagnosis.

scholarly journals Real-time Point-of-care Ultrasound for the Diagnosis and Treatment of Testicular Torsion

POCUS Journal ◽  
2021 ◽  
Vol 6 (2) ◽  
pp. 70-72
Author(s):  
Rahul V. Nene ◽  
Rachna Subramony ◽  
Michael Marcias ◽  
Colleen Campbell ◽  
Amir Aminlari
Keyword(s):  
Blood Flow ◽  
Real Time ◽  
Testicular Torsion ◽  
Point Of Care ◽  
Diagnosis And Treatment ◽  
Acute Scrotum ◽  
Point Of Care Ultrasound ◽  
Scrotal Pain ◽  
Real Time Analysis ◽  
Acute Scrotal Pain

Background: Testicular torsion is a surgical emergency that needs prompt diagnosis and treatment. Point-of-Care ultrasound (POCUS) can not only establish the diagnosis but also guide the Emergency Physician in evaluating the response to manual detorsion. Case Report: We describe the case of a 13-year-old male who presented with acute scrotal pain. We demonstrate how bedside ultrasound was used to make the diagnosis of testicular torsion, guide the technique for manual detorsion, and confirm adequate return of blood flow. Our case illustrates the ease with which POCUS can be used in real time to diagnose and treat organ-threatening pathology, but more importantly, it shows how real-time POCUS was used to detorse a testicle that was refractory to the standard detorsion technique. Conclusion: The acute scrotum is a time-sensitive presentation and if testicular torsion is present, the diagnosis should be made as soon as possible. Many Emergency Departments do not have 24-hour coverage of ultrasound technicians, which would delay the diagnosis and treatment. Moreover, when manual detorsion is attempted, it often does not work because the testicle may need more than the standard 180 degree medial to lateral rotation. POCUS provides real-time analysis of return of blood flow and can thus guide further rotation, or opposite direction rotation, as needed.  

scholarly journals Testicular Torsion and Contralateral Torsion of the Appendix Testis

2021 ◽  
Author(s):  
Oğuzhan Yusuf Sönmez ◽  
Mehmet Sevim ◽  
Halil İbrahim İvelik ◽  
Burak İşler ◽  
Bekir Aras
Keyword(s):  
Testicular Torsion ◽  
Color Doppler ◽  
Color Doppler Ultrasound ◽  
Clinical Suspicion ◽  
Acute Scrotum ◽  
Hormonal Stimulation ◽  
Scrotal Pain ◽  
Mild Abdominal Pain ◽  
Urological Emergency ◽  
Appendix Testis

Testicular torsion is a urological emergency that results in deterioration of the blood supply of the testicle and ischemia as a result of the rotation of the spermatic cord around itself. It may show a wide clinical variety with inflammatory manifestations varying from mild abdominal pain to severe scrotal pain. Orchiectomy may be required in cases which are delayed and cannot be operated urgently. Torsion of the testis and epididymis are other frequently seen causes of acute scrotum in children. Growth of masses and hormonal stimulation in the adolescent age cause an increase in the tendency of the torsion of appendix testis which have a small pedicle and epididymis. In the presence of sudden scrotal pain, testicular torsion should be considered, if there is clinical suspicion, patients should be evaluated with color doppler ultrasound (CDUS) and scrotal exploration should be performed immediately. A 20-year-old male whose clinical picture, and scrotal ultrasonography suggested the presence of testicular torsion is presented in this case report.

scholarly journals Comparison of demographic and clinical characteristics in distinguishing testicular torsion from torsion of the appendix testis

2021 ◽  
Author(s):  
Zlatan Zvizdic ◽  
Amila Aganovic ◽  
Emir Milisic ◽  
Asmir Jonuzi ◽  
Denisa Zvizdic ◽  
...  
Keyword(s):  
Abdominal Pain ◽  
Clinical Characteristics ◽  
Testicular Torsion ◽  
Pediatric Population ◽  
Color Doppler ◽  
Medical Emergency ◽  
Acute Scrotum ◽  
Scrotal Pain ◽  
Duration Of Symptoms ◽  
Appendix Testis

Abstract Purpose The acute scrotum (AS) in the pediatric population is a medical emergency. The most common causes of AS include testicular torsion (TT) and torsion of the appendix testis (TAT). Their distinction may be clinically challenging. The purpose of our study was to compare demographic and clinical characteristics of the pediatric cases of TT and TAT and thus provide clinical evidence for distinguishing these two conditions. Methods We retrospectively analyzed all children ≤ 16 years who underwent surgical exploration for AS. The patients were divided into Group 1 or TT and Group 2 or TAT groups. Results Ninety patients were included in the study (24 with TT and 66 with TAT). Patients with TT were significantly older than those with TAT (p < 0.001). The peak incidence of TT was in the age of 12–16 years (p < 0.001), whereas the peak of TAT was in the age group of 7–11 years (p < 0.001). Scrotal pain was more prevalent in patients with TAT (p = 0.02), whereas systemic signs (nausea/vomiting and abdominal pain) affected more frequently the TT patients (p = 0.003 and p < 0.001, respectively). The mean duration of symptoms was significantly longer in the TAT group than in the TT group (p < 0.001). Color-Doppler Ultrasound (CDUS) findings of absent or decreased testicular blood flow in the affected testis strongly favored the diagnosis of TT (p < 0.001). Conclusion Our data indicate that the older age, shorter duration of symptoms, systemic signs (nausea/vomiting and abdominal pain), and characteristics CDUS findings can help distinguish between the two most common acute scrotum causes.

Causes of delayed exploration of the acute scrotum in a regional tertiary centre

2020 ◽  
pp. 205141582098119
Author(s):  
Benjamin Storey ◽  
Nathan Shugg ◽  
Alison Blatt
Keyword(s):  
Retrospective Review ◽  
Testicular Torsion ◽  
Tertiary Hospital ◽  
Adverse Outcomes ◽  
Acute Scrotum ◽  
Tertiary Institution ◽  
Level Of Evidence ◽  
Scrotal Pain ◽  
Surgical Exploration ◽  
Significant Difference

Background: Testicular torsion is an organ-threatening surgical emergency with a limited timeframe for intervention. Objective: To identify the delays to surgical exploration of patients with an acute scrotum in a tertiary hospital to prevent adverse outcomes associated with this time critical emergency. Methods: A retrospective review of medical records for all patients who underwent scrotal exploration for acute scrotal pain in a tertiary hospital in regional New South Wales between January 2008 to December 2018 was performed. Results: Retrospective review identified 242 patients, of whom 161 had testicular torsion and 56 resultant orchidectomies. No statistically significant difference in pre-hospital delays between paediatric or adult populations was found. The average time from presentation to theatre was 4 h 36 min. Patients who were delayed > 6 h from presentation to surgical exploration had significantly increased rates of orchidectomy. Delays that significantly affected rates of orchidectomy were transfer from peripheral sites, late presentation, misdiagnosis and representation after discharge. Conclusion: The most common reason for delay was diagnostic error with the patient later re-presenting to hospital. Patient transfer from the primary hospital to a tertiary institution and subsequent delayed surgical exploration also contributed to significantly higher rates of orchidectomy. Level of Evidence: 3

Qualitative Diagnosis of Solid Breast Mass by Blood Flow in Solid Breast Mass Based on Color Doppler Ultrasound

2021 ◽  
Vol 11 (6) ◽  
pp. 1608-1615
Author(s):  
Ding Zuopeng ◽  
Liu Weiyong ◽  
Hu Chunmei ◽  
Wang Tao ◽  
Wang Mingming
Keyword(s):  
Breast Cancer ◽  
Blood Flow ◽  
Differential Diagnosis ◽  
Color Doppler ◽  
Flow Characteristics ◽  
Flow Distribution ◽  
Color Doppler Ultrasound ◽  
Blood Flow Distribution ◽  
Breast Masses ◽  
Malignant Breast

The incidence of breast cancer ranks first among female malignant tumor. With the increase of the sensitivity of color Doppler ultrasound blood flow, the blood flow distribution in and around the tumor can be clearly displayed, and the analysis of hemodynamic parameters is provided, which provides convenience for the study of tumor blood flow characteristics. Studies have shown that tumor cells can secrete a substance called angiogenesis factor, which makes the tumor site form a rich vascular network to promote tumor growth and metastasis. The tumor has many new blood vessels, abnormal structure, thin wall, lack of muscle layer, and is prone to form arteriovenous rash. These characteristics provide a pathological basis for color Doppler flow imaging (CDFI) for the diagnosis of breast cancer. This article discusses the role of two-dimensional sonographic features in the differential diagnosis of benign and malignant breast masses, CDFI was used to study the blood flow distribution and hemodynamic characteristics in benign and malignant breast masses; explore the value of blood flow characteristics and blood flow parameters in the differential diagnosis of breast masses. The experimental results show that the detection rate of blood flow signals and the classification of blood flow signals in the malignant group are higher than those in the benign group, mainly level II and III blood flow, and the irregular branched blood flow is more common, especially when the tumor appears penetrating blood flow supports the diagnosis of malignancy. PSV, RI and PI have a certain differential meaning in the diagnosis of benign and malignant breast masses. PSV, RI and PI of malignant masses are higher than benign masses. For tumors without obvious necrosis, the larger the tumor diameter, the richer the blood flow and the higher the blood flow grade is. The malignant tumors have more blood flow than the benign ones.

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