B‐mode and colour‐flow duplex ultrasonography: a useful adjunct in diagnosing scrotal diseases?

Abstract

Objective To determine the value of ultrasonography (US) and colour‐flow duplex ultrasonography (CFD) as routine investigations in the diagnosis of scrotal pathologies. Patients and methods The imaging techniques were applied to 215 consecutive patients with scrotal complaints. The diagnosis of a urologist (D1, made from the patient's history, physical examination and laboratory results) and that of the radiologist (D2, using US and CFD) were compared with the ‘gold standard’ (D3, the operative findings and course of the disease). The sensitivity and specificity of the diagnostic pathways (D1, D2) were determined statistically and compared with D3. Results The final diagnoses (D3) were testicular torsion (13 patients), torsion of the appendix testis (5), epididymitis (42), inguinal hernia (7), tumour (11), trauma (9), hydrocele (46), epididymal cyst (37), orchitis (10), varicocele (46) and other diagnoses (8). Using D1, the urologist missed seven diagnoses, of which one was a patient with a testicular torsion combined with an inguinal hernia, and one a patient with a tumour. Using US and CFD (D2), the radiologist missed five diagnoses, including one patient with combined testicular torsion and inguinal hernia. Conclusion For the diagnosis of scrotal disorders, the basic clinical evaluation usually provides the correct diagnosis. However, US and CFD are useful adjuncts which cause a minimal burden to the patient and that in most cases will lead to the correct diagnosis, especially with important diagnoses like testicular torsion, when US and CFD should be performed immediately. If this does not provide a clear diagnosis, the patient should be explored surgically.

Consensus on genitourinary trauma: external genitalia

“…Enlargement of the epididymis may suggest either an epididymal haematoma or post-traumatic epididymitis. Colour and pulsed Doppler SUS may diagnose testicular torsion where vascular flow of the gonad is absent [19]. Although MRI has been used to aid in the diagnosis of rupture in equivocal cases, widespread clinical use is not the norm as it is expensive and time-consuming [20,21].…”

Acute epididymitis

“…Testicular torsion, which has a high risk of testicular infarction if surgical treatment is delayed, is characterized by a shorter history of ≈4 h at presentation [51]. The diagnosis is suggested by the testicular position, high and transverse in the scrotum [52]. If there is any diagnostic uncertainty, surgical exploration is mandatory.…”

“…The role of imaging in distinguishing acute epididymitis from testicular torsion has been evaluated in several studies. In 215 patients with a range of acute and nonacute scrotal symptoms, basic clinical evaluation generally provided the correct diagnosis [52]. On physical examination, the testicular position may suggest torsion; swelling and reddening of the scrotum may be present in both infection and torsion.…”

“…On physical examination, the testicular position may suggest torsion; swelling and reddening of the scrotum may be present in both infection and torsion. In epididymitis, B‐mode ultrasonography showed an enlarged, echo‐poor epididymis; colour‐flow Doppler ultrasonography shows hypervascularity [52]. In testicular torsion, the testicular size is increased with a change in the position of the epididymis and increased homogeneous hypo‐echogenicity is seen on B‐mode ultrasonography; colour Doppler study shows a reduced or absent vascular signal and peritesticular hyperaemia.…”

Adult spinal cord injury without radiological abnormality

“…23 However, where physical examination is equivocal, colour Doppler ultrasonography or scintigraphy may be helpful in establishing the diagnosis. [23][24][25] The immediate testicular survival rate and the subsequent testicular atrophy and impairment in testicular function are directly related to the duration and the degree of the torsion. 1 3 6-9 18 20 21 Only 4% of testis are found to be non-viable in acute torsion of less than 12 hours duration compared with a 75% infarction rate if the history was greater than 12 hours.…”