Ultrasonological evaluation of acute scrotum

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.

Download Full-text

Difference in declarative tactical knowledge between U-11 and U-15 soccer players

Human Movement ◽

10.1515/humo-2017-0045 ◽

2017 ◽

Vol 18 (5) ◽

Cited By ~ 1

Keyword(s):

Statistical Analysis ◽

Descriptive Analysis ◽

Age Groups ◽

Verbal Report ◽

Soccer Players ◽

Age Group ◽

Simulation Test ◽

Significance Level ◽

Practice Time ◽

Tactical Knowledge

AbstractPurpose. The aim of this study was to compare the level of declarative tactical knowledge between U-11 and U-15 academy players. Methods. The sample comprised 36 U-11 (n = 18) and U-15 (n = 18) soccer players, with practice time of 1404.00 ± 469.52 hours and 2663.55 ± 594.91 hours, respectively. The players’ practice time was collected through a recording questionnaire. Declarative tactical knowledge was assessed through a verbal report used during a video simulation test. The answers provided during the test were scored as follows: best solution (1 point); second best solution (0.75 points); third best solution (0.50 points); fourth best solution (0.25 points); wrong solution (0 points). For statistical analysis, descriptive analysis was performed, as well as the Shapiro-Wilk and Mann-Whitney tests, with significance level set at p < 0.05. For statistical purposes, the SPSS 22.0 software was applied. Results. Significant differences were observed in declarative tactical knowledge between the U-11 and U-15 age groups. Players of the older age group displayed longer practice time and higher scores than their younger counterparts. Conclusions. Players with longer practice time (U-15) possess greater declarative tactical knowledge than those with less practice time (U-11), and declarative tactical knowledge is a factor that differentiates soccer players aged 11 and 15 years.

Download Full-text

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

Medicinski pregled ◽

10.2298/mpns2102038d ◽

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.

Download Full-text

Acute testicular vein thrombosis in a young patient with a solitary testicle: a rare urological emergency

Yeni Üroloji Dergisi ◽

10.33719/yud.2021;16-2-769944 ◽

2021 ◽

pp. 195-199

Author(s):

Ali Kumcu ◽

Ferhat Yakup Suçeken ◽

Metin Mod ◽

Alper Kerem Aksoy ◽

Abdurrahman İnkaya ◽

...

Keyword(s):

Case Reports ◽

Color Doppler ◽

Rare Condition ◽

Current Treatment ◽

Acute Scrotum ◽

Scrotal Pain ◽

Testicular Vein ◽

Vein Thrombosis ◽

First Choice ◽

Urological Emergency

Acute scrotal pain due to testicular vein thrombosis is a rare condition. Thrombosis is defined as clot formation within the blood vessels and as a result, it interrupts the blood supply of the peripheral organs. In routine urology practice, the incidence of thromboembolic diseases is <1%, and it is mostly encountered in patients at the postoperative period. Nevertheless, testicular vein thrombosis should also be remembered in the differential diagnosis of patients admitted to the emergency department due to acute scrotum. In general, conservative treatment is the first choice in treatment management, but surgical intervention may also be required in some cases. Since the available data on this subject are based on the information obtained from case reports, a standard treatment approach should be developed by examining the current treatment methods. We aim to present the case report of testicular vein thrombosis in the light of the literature, which is one of the rarely seen emergencies of urology. Keywords: acute pain; color doppler ultrasonography; venous thrombosis; testicular diseases

Download Full-text

Acute Idiopathic Scrotal Edema

Case Reports in Urology ◽

10.1155/2013/829345 ◽

2013 ◽

Vol 2013 ◽

pp. 1-3 ◽

Cited By ~ 1

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.

Download Full-text

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

American Journal of Men s Health ◽

10.1177/1557988320953003 ◽

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.

Download Full-text

Acute scrotum: differential diagnosis and treatment

Revista de Medicina ◽

10.11606/issn.1679-9836.v97i3p278-282 ◽

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.

Download Full-text

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

Case Reports in Medicine ◽

10.1155/2018/2862514 ◽

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.

Download Full-text

“Study of Etiology of Acute Scrotum and Its Management”

International Journal Of Medical Science And Clinical Invention ◽

10.18535/ijmsci/v7i11.08 ◽

2020 ◽

Vol 7 (11) ◽

pp. 5111-5116

Author(s):

Ketika Potey ◽

Ashish Shahurao Bangar ◽

Anita Kandi ◽

Sarojini Jadhav

Keyword(s):

Testicular Torsion ◽

Color Doppler ◽

Tertiary Care ◽

Clinical Manifestations ◽

Final Diagnosis ◽

Acute Scrotum ◽

Delayed Presentation ◽

Tertiary Care Centre ◽

Vast Number ◽

Laboratory Test Results

Introduction: Acute Scrotum is an emergency with vast number of differential diagnoses with potential to have short and long term complications. Low salvage rates are often secondary to misdiagnosis and delayed presentation. Late presentation remains the greatest cause of orchiectomy.Many studies had been conducted, on whether every patient of acute scrotum should be explored or not on solely clinical grounds. Objective: The purpose of this study was to study the etiology, age incidence, the differential diagnosis and complications in patients with acute scrotum. Methods: The present prospective observational study was carried out at a tertiary care centre from August 2015 to November 2017 amongst 102 patients diagnosed and admitted for acute scrotum. Results: Out of 102 patients acute scrotum majority 74 (72.54%) had epididymitis and/or orchitis, 6 (5.88%) testicular torsion, 20(18.6%) pyocoele. In final diagnosis, we got 20 patients of pyocoele but only 17 patients were diagnosed clinically, while 3 patients were earlier diagnosed as epididymo-orchitis. Out of 6 patients of testicular torsion, in 3 patients we were able to save testis and bilateral orchiopexy was done. Out of 20 patients of pyocoele, 3 patients were complication of epididymo-orchitis and 2 of testicular torsion. In 8 patients with gangrenous testis orchiectomy was performed. Conclusion: Overlap exists between testicular torsion and other conditions of acute scrotum in the younger population. The clinical manifestations, physical examination findings, and laboratory test results are helpful in distinguishing the etiology; however, ultrasonography and color Doppler help in the diagnosis and immediate treatment for testicular torsion.

Download Full-text

Testicular Torsion and Contralateral Torsion of the Appendix Testis

Grand Journal of Urology ◽

10.5222/gju.2021.25745 ◽

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.

Download Full-text

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

10.21203/rs.3.rs-461129/v1 ◽

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.

Download Full-text