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 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 Acute Idiopathic Scrotal Edema

2013 ◽  
Vol 2013 ◽  
pp. 1-3 ◽  
Author(s):  
Micheál Breen ◽  
Kevin Murphy ◽  
Jeanne Chow ◽  
Eamon Kiely ◽  
Kevin O’Regan
Keyword(s):  
Natural History ◽  
Clinical Features ◽  
Color Doppler ◽  
Acute Scrotum ◽  
Ultrasound Technique ◽  
Scrotal Pain ◽  
Acute Scrotal Pain ◽  
Scrotal Edema ◽  
History Of ◽  
Rare Diagnosis

We report a case of acute idiopathic scrotal edema (AISE) in a 4-year-old boy who presented with acute scrotal pain and erythema. The clinical features, ultrasound appearance, and natural history of this rare diagnosis are reviewed. In this report, we highlight the importance of good ultrasound technique in differentiating the etiology of the acute scrotum and demonstrate the color Doppler “Fountain Sign” that is highly suggestive of AISE.

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 Ultrasonological evaluation of acute scrotum

2018 ◽  
Vol 6 (1-2) ◽  
pp. 11-14
Author(s):  
Prakash Sharma ◽  
Merina Gyawali ◽  
Sristi Singh
Keyword(s):  
Statistical Analysis ◽  
Color Doppler ◽  
Descriptive Analysis ◽  
Power Doppler ◽  
Rank Correlation ◽  
Final Diagnosis ◽  
Acute Scrotum ◽  
Age Group ◽  
Scrotal Pain ◽  
Kendall Rank Correlation

Introduction: Acute scrotum is a common surgical condition. Ultrasound along with Doppler plays an important role in differentiating the various causes. Purpose of this study was to evaluate the role of ultrasound in identifying the various causes of acute scrotum.Methods: All patients with history of acute scrotum presenting to the Department of Radiology were included in the study. Scrotal ultrasound was performed with a linear 7.5 to 12-MHz transducer with abundant acoustic gel. Imaging was done in longitudinal and transverse planes with Power Doppler and Color Doppler. The testes, epididymis, spermatic cord, scrotal wall and inguinal region were evaluated. Kidney, Ureter and Bladder region was evaluated for possibility of calculus. Final diagnosis was made based on clinical outcome, follow up, intraoperative findings and histopathology when available. Statistical analysis was done using SPSS version 18 for windows. Descriptive analysis was done. Non parametric correlation between side and torsion was done using Kendall Rank Correlation Coefficient.Results: There were altogether 50 patients available for statistical analysis. Age of the patients ranged from 14 to 65 years with mean age of 34.7±14.7 years. Most common age group was 21 to 40 years. Inflammatory pathology was the most common pathology of actual scrotal pain. There was no significant correlation between side of pain and testicular torsion.Conclusion: Inflammatory pathology was the most common cause for actual scrotal pain. The most common age group was 21 to 40 years.

Acute Testicular Torsion: Presentation and Diagnosis

2019 ◽  
Author(s):  
Claudia Berrondo ◽  
Robert A. Mevorach ◽  
Jimena Cubillos
Keyword(s):  
Testicular Torsion ◽  
Near Infrared ◽  
Color Doppler ◽  
Bimodal Distribution ◽  
Long Term Effects ◽  
Scrotal Pain ◽  
Unique Challenge ◽  
Acute Infarction ◽  
Hormonal Function ◽  
Acute Scrotal Pain

Testicular torsion is the most common pediatric urologic emergency and is a common cause of acute scrotal pain. Timely diagnosis is important for testicular salvage,as treatment delayed beyond 6 hours from the onset of symptoms is the most predictive factor of testicular death. There is a bimodal distribution of age with extravaginal torsion most commonly presenting in the neonatal period and intravaginal torsion most commonly presenting around the onset of puberty. Intermittent testicular torsion presents a unique challenge in making an accurate diagnosis, as patients most often present when asymptomatic. Several risk factors exist, although bell-clapper deformity is the most important. The diagnosis is made largely on history or physical examination. In equivocal cases, imaging with color Doppler ultrasonography may be helpful in making the diagnosis. Additional tools including near-infrared spectroscopy and Testicular Workup for Ischemia and Suspected Torsion score may be helpful in diagnosing testicular torsion. Possible long-term effects on fertility and hormonal function are also often a concern for the patient and clinician. This review contains 6 figures, 5 tables, and 34 references.  Keywords: acute, infarction, ischemia, orchidopexy, scrotum, spermatic cord, testis, torsion

Approach to Male Urologic Emergencies

2019 ◽  
Author(s):  
Jonathan E. Davis ◽  
Jeffrey S. Dubin
Keyword(s):  
Emergency Department ◽  
Inguinal Hernia ◽  
Necrotizing Fasciitis ◽  
Testicular Torsion ◽  
Diagnosis And Treatment ◽  
Acute Scrotum ◽  
Scrotal Pain ◽  
Penile Pain ◽  
Emergency Department Setting ◽  
Acute Scrotal Pain

This review details the evaluation and management of the acute scrotum in the emergency department setting and emergent penile complaints in adults, with an emphasis on the most serious and most common conditions. Other emergent conditions include necrotizing fasciitis of the perineum (Fournier disease), incarcerated or strangulated inguinal hernia, and genitourinary (GU) trauma. Emergency practitioners need to be most concerned with the entities that, if left untreated, can result in ischemia and necrosis of the penis. Basic anatomy and bedside evaluation are reviewed. Acute scrotal and penile pain and GU trauma are discussed in terms of assessment and stabilization, diagnosis, and treatment and disposition.  This review contains 5 figures, 19 tables, and 71 references. Keywords: Acute scrotal pain, testicular torsion, priapism, Peyronie disease, paraphimosis, phimosis, balanitis, posthitis, epididymitis

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.

Color Doppler sonography and scintigraphy of the testis: A prospective, comparative analysis in children with acute scrotal pain

2002 ◽  
Vol 18 (2) ◽  
pp. 67-71 ◽  
Author(s):  
ANNA R. NUSSBAUM BLASK ◽  
DOROTHY BULAS ◽  
EGLAL SHALABY-RANA ◽  
GIL RUSHTON ◽  
CHENG SHAO ◽  
...  
Keyword(s):  
Comparative Analysis ◽  
Doppler Sonography ◽  
Color Doppler ◽  
Color Doppler Sonography ◽  
Scrotal Pain ◽  
Acute Scrotal Pain

scholarly journals MODERN CAPABILITIES OF ULTRASOUND VISUALIZATION OF ABDOMINAL WALL HERNIAS

2018 ◽  
Vol 18 (1) ◽  
pp. 94-100
Author(s):  
Y P Zorin ◽  
M G Boitsova ◽  
NA A Karlova ◽  
A V Shabrov
Keyword(s):  
Differential Diagnosis ◽  
Abdominal Wall ◽  
Ultrasound Examination ◽  
Color Doppler ◽  
Standard Procedure ◽  
Correct Diagnosis ◽  
Dynamic Control ◽  
Abdominal Wall Hernia ◽  
Adequate Treatment ◽  
Scanning Procedure

Abdominal wall hernias are the common pathology in modern clinical practice. Clinical data sometimes make the correct diagnosis not possible what requires the timely specific and targeted ultrasound examination. Aims of research. Revealing the capabilities of ultrasound examination at the assumption of abdominal wall hernias. Materials and methods. Within four years the ultrasound examination of 88 patients was carried out who suffered from different abdominal wall hernia, with the use of standard procedure of ultrasound examination and specific tests for evaluation of the condition of hernia’s content. The ultrasound scanning procedure was performed using B-mode and Color Doppler mapping mode. The majority of patients hereafter underwent the planned or emergency surgical treatment and subsequent ultrasound dynamic control. Results. The ultrasound examination gave the opportunity to reveal hernias in all the patients examined. Standards of morphometry, conditions of successful diagnosis and criterions of differential diagnosis signs of abdominal wall hernias have been detected. Criterions of differentiation of non-complicated and complicated hernias were concretized Conclusions. Ultrasound examination is a highly informative method for search, diagnosis and differential diagnosis of abdominal wall hernias. The targeted search of specific ultrasound signs allows making a correct diagnosis what has a great value for the timing of beginning of the adequate treatment.

scholarly journals Role of ultrasound and color Doppler in the evaluation of acute scrotal pain

2018 ◽  
Vol 50 (1-2) ◽  
pp. 26-30
Author(s):  
Gazi Salahuddin ◽  
SM Zulker Nayeem ◽  
Syed Mozammel Hossain ◽  
Sadika Parvin ◽  
Md Monoar Hossain
Keyword(s):  
Morphological Changes ◽  
Color Doppler ◽  
Definitive Diagnosis ◽  
Relative Importance ◽  
Colour Doppler ◽  
Gray Scale ◽  
Scrotal Pain ◽  
Doppler Study ◽  
Acute Scrotal Pain

Background: Traditionally acute scrotal pain is evaluated by gray scale ultrasound, which dissipated only the morphological changes of the lesion. But pattern of vascularity either normal, increased or absent of affected structure help to definitive diagnosis of the lesion and help to proceed the type of management either medical therapy or surgical treatment.Objectives: To determine the relative importance of color Doppler in the evaluation of acute scrotal pain by ultrasound.Methods: From June 2013 to June 2017 a total 150 patients with acute scrotal pain were selected. A thorough history taking and physical examination were done. Then patient were scanned with gray scale ultrasound followed by color Doppler study. Color Doppler diagnosis is compared with gray scale diagnosis.Results: In gray scale ultrasonography among the 150 cases, 54% were diagnosed as epididymitis, 16.66% were epididymo-orchitis and 16% patient diagnosed as normal. But in combined gray scale and colour Doppler study 58% were diagnosed as epididymitis, 22% were epididymo-orchitis and 6% of patient diagnosed as normal. In gray scale 10% patient were diagnosed as normal but become epididymitis and epididymo-orchitis in colour Doppler. Four percent were diagnosed as epididymitis in gay scale but became epididymo-orchitis in colour Doppler. Four percent patient was diagnosed as epididymitis orchitis but became testicular torsion in Doppler study. Total 14.66% of gray scale diagnosis became another diagnosis in the Doppler study.Conclusion: Combined gray scale and color Doppler study is superior than gray scale ultrasound in differentiating various cause of acute scrotal pain.Bang Med J (Khulna) 2017; 50 : 26-30

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