Acute Segmental Testicular Infarction at Contrast-Enhanced Ultrasound: Early Features and Changes During Follow-Up

Bertolotto, Michele; Derchi, Lorenzo E.; Sidhu, Paul S.; Serafini, Giovanni; Valentino, Massimo; Grenier, N.; Cova, Maria Assunta

doi:10.2214/ajr.10.4821

Cited by 104 publications

(112 citation statements)

References 26 publications

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“…Colour Doppler imaging provides an overview of vascularity but has limitations. Contrast-enhanced ultrasound (CEUS) with SonoVue TM (Bracco SpA, Milan, Italy) allows more accurate delineation of areas of nonperfused testicular tissue and should always be employed if the colour Doppler examination is equivocal [2][3][4].…”

Section: Examination Techniquementioning

confidence: 99%

“…Lying at the upper aspect is an ill-defined circular mass representing the thickened, oedematous torted spermatic cord (arrow). The scrotal wall is also thickened aided with the use of spectral Doppler or CEUS; spectral Doppler may show an increased resistive index [10], whilst CEUS allows accurate direct visualisation of absence of intra-testicular enhancement clearly depicting infarction [2,3] (Fig. 2).…”

Section: Torsion Of the Spermatic Cordmentioning

confidence: 99%

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A review of ultrasound imaging in scrotal emergencies

Yusuf

Sidhu

2013

J Ultrasound

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Scrotal emergencies represent a small proportion of admissions to the emergency department; however, the intimate nature and potential for serious outcome often cause great anxiety. Rapid assessment is required to exclude fertility-threatening conditions and expedite surgical management. Ultrasound is an essential tool in acute scrotal assessment as it allows rapid, radiation-free, highresolution imaging and, importantly, assessment of vascularity with colour Doppler imaging. In the presentation of the acute scrotum, the ''on-call'' practitioner will frequently be asked to exclude pathology requiring surgical management, in particular torsion of the spermatic cord. To provide an accurate evaluation the individual is required to have an understanding of scrotal anatomy, sonographic technique and recognition of pathology. This review article will familiarise the reader with the sonographic findings of common acute scrotal pathology.Sommario Le emergenze scrotali rappresentano una piccola percentuale di accessi al pronto soccorso, ma la natura intima e la possibilità di esiti seri sono spesso causa di grande ansia. E' necessaria una valutazione rapida, al fine di escludere condizioni di pericolo per la fertilità e accelerare il trattamento chirurgico. L'ecografia è uno strumento essenziale per la valutazione dello scroto acuto in quanto rapida, esente da radiazione, ad alta risoluzione e, soprattutto, permette la valutazione della vascolarizzazione con colour Doppler. Nello scroto acuto l'ecografista spesso verrà chiamato a escludere patologie che richiedono un trattamento chirurgico, in particolare la torsione del funicolo spermatico. Al fine di fornire una valutazione precisa è tenuto ad avere una conoscenza dell'anatomia scrotale, della tecnica ecografica e a conoscere le varie patologie. Questo articolo di revisione ha lo scopo di familiarizzare il lettore con gli aspetti ecografici della patologia scrotale acuta più frequente.

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Section: Examination Techniquementioning

confidence: 99%

Section: Torsion Of the Spermatic Cordmentioning

confidence: 99%

A review of ultrasound imaging in scrotal emergencies

Yusuf

Sidhu

2013

J Ultrasound

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“…Segmental testicular infarct is a rare entity that usually presents with an insidious onset of scrotal pain and tenderness with no other findings on clinical or hematological investigations [1,7,8]. The etiology is usually idiopathic; however, cases have been associated with hypercoagulability, vasculitis, torsion, trauma, infection and iatrogenic vessel damage [1].…”

Section: Discussionmentioning

confidence: 99%

“…The etiology is usually idiopathic; however, cases have been associated with hypercoagulability, vasculitis, torsion, trauma, infection and iatrogenic vessel damage [1]. The first line imaging investigation is usually grey-scale sonography with colour Doppler; however, CEUS [7,8] and RTE [9] are being used to improve characterization of these lesions.…”

Section: Discussionmentioning

confidence: 99%

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Metachronous bilateral segmental testicular infarction: multi-parametric ultrasound imaging with grey-scale ultrasound, Doppler ultrasound, contrast-enhanced ultrasound (CEUS) and real-time tissue elastography (RTE)

2014

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Segmental testicular infarction is a rare cause of acute scrotal pain. The appearances on grey-scale sonography are often indistinguishable from that of a testicular tumour, resulting in unnecessary orchiectomy. We report a case of acute bilateral testicular infarction, of unknown etiology, which was conservatively managed to resolution following a confident diagnosis achieved with the aid of contrast-enhanced ultrasound (CEUS) and real-time tissue elastography (RTE) along with conventional grey-scale and Doppler sonography. The evolving appearances on each of the sonographic modalities are described. We discuss the importance of complementing conventional sonography with CEUS and RTE in order to make a confident diagnosis and avoid unnecessary surgical intervention.Riassunto L'infarto testicolare segmentale è una causa rara di dolore scrotale acuto. L'aspetto ecografico, in scala di grigi, è spesso indistinguibile da quello di un tumore testicolare, con conseguenti orchiectomie inutili. Riportiamo un caso di infarto testicolare acuto bilaterale, ad eziologia sconosciuta, gestito in maniera conservativa fino a risoluzione, dopo una diagnosi realizzata con l'ausilio di ecografia con messo di contrasto (CEUS) e elastosonografia tessutale in tempo reale (RTE), ecografia convenzionale in scala di grigi e Doppler. Sono descritti gli aspetti, in ciascuna delle modalità ecografiche, dell'evoluzione delle lesioni. Discutiamo l'importanza della complementarietà dell'ecografia convenzionale con CEUS e RTE per effettuare una diagnosi di certezza ed evitare un inutile intervento chirurgico.

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