Clinical and sonographic criteria of acute scrotum in children: a retrospective study of 172 boys

Abstract

We suggest that all children with acute scrotal pain and a clinical score of 3 should undergo testicular exploration, and children with a lower probability of testicular torsion (score 1 or 2) should first undergo diagnostic ultrasound. Because the presence of testicular flow does not exclude torsion, the spermatic cord should be meticulously evaluated in all children with acute scrotum and normal or increased testicular blood flow.

A Retrospective Study of Torsion of Testis - Presentation and Its Management in Our Institution

“…This can be accomplished by manual detorsion through a surgery or in the case of necrosis orchiectomy. [11]- [14] According to our findings most of the cases were affected on the left side and bilateral involvement was rare, but in an African study with the similar range of age to our study only 36% presented with testicular torsion with the more frequency on the right side (41.3%). In 23.3% cases both testicles were involved.…”

Sonographic appearances of the epididymis in boys with acute testicular torsion but preserved testicular blood flow on color Doppler

“…Although recent studies have shown high sensitivity (96-100%) and specificity (75.2-95%) of color Doppler sonography in the diagnosis of testicular torsion [3][4][5], the gradual reduction of testicular perfusion in the initial torsion [14] and the presence of testicular flow in partial torsion of 180°or 90° [5,6,12] can lead to missed torsion if the diagnosis is based solely on color Doppler sonography findings. Color Doppler image shows intratesticular flow in the affected testis and the head of the epididymis, with a small oval shape at the top of the testis (arrow) caused by its lateral displacement.…”

“…Experimental studies have also shown that testicular vessels may not be compromised in incomplete torsion of the spermatic cord [6].…”

“…Absent or decreased flow of the affected testis is the diagnostic finding of torsion on color Doppler sonography [6]. However, presence of flow on color Doppler can be misleading, especially in cases of partial torsion [6,7].…”

Epididymal or Testicular Ultrasonic Findings: Which One is More Reliable for Differentiation of Testicular Torsion from Epididymitis?

“…Ultrasound is the primary modality for the evaluation of patients with acute scrotal pathologies (3,4) and testicular torsion can cause changes in grey-scale, color, and spectral Doppler sonography depending on the degree of twist and the duration of symptoms (2). Sonographic findings of testis in these patients vary from normal pattern to spherical enlargement and eventually, atrophy, abnormal axis of affected testis, diffusely hypoechoic echo texture, heterogeneous, focal or multifocal echogenicity due to hemorrhagic infarction, thick mediastinum, and absence or decreased blood flow in the affected testis (1,2,5,6). However, the presence of the color signal in a portion of the testis (usually near or inside the mediastinum) does not exclude spermatic cord torsion (6).…”