Torsion and Beyond

Abstract

Objective. To illustrate how spectral Doppler waveform analysis plays an adjunctive but very definite role in scrotal sonography. Methods. The cases illustrate a variety of testicular disorders that were collected at a referral tertiary care center. Results. Normal and a variety of pathologic conditions of the testes are discussed, along with their signature spectral waveforms. Conclusions. Analysis of the spectral waveform provides important additional information in various scrotal disorders with acute pain. Spectral waveform analysis is critical to diagnosing incomplete torsion when color and power Doppler examinations are indeterminate. Key words: arteriovenous malformation; varicocele; epididymoorchitis; resistive index; spectral Doppler sonography; testis; torsion. onography is the primary modality for evaluating scrotal disorders. Color, power, and spectral Doppler sonography are extensively used for evaluating patients with a painful scrotum. 1-3 Frequency spectrum analysis is an essential element of vascular sonography. Sonographers and sonologists should be familiar with the various subtle variations in spectral waveforms and the enormous amount of information provided by this technique. The purpose of this presentation is to illustrate how spectral waveform analysis plays an adjunctive but very definite role in scrotal sonography. Normal Spectral Doppler CharacteristicsThe spermatic cord contains the testicular artery, the artery to the vas deferens, and the cremasteric artery supplying blood to the testis, epididymis, and scrotal wall, respectively. In descending order, they arise from the abdominal aorta, superior vesicle artery, and inferior epigastric artery. 1,4 Proper interpretation of velocity waveforms requires an understanding of the normal waveform characteristics of a given vessel and of the physiologic status of the circulation subtended by the vessel. The normal spectral waveform of the testicular artery and artery supplying the epididymis is a lowresistance, high-flow pattern (Figure 1), whereas that of the cremasteric artery supplying the scrotal wall has a high-resistance, low-flow pattern (Figure 2). 5,6

Role of the scrotal color Doppler ultrasound findings in management of severe orchitis to do orchiectomy

“…Studies show that RI <0.5% can be indicative of healthy vascular status compared with the orchitis. Besides, high levels of RI can be indicative of an ischemia caused by an outflow vessel blocking while this condition is a medical emergency status, which requires surgical intervention (12,13). The current study also indicated that patients with a higher RI were more likely to have undergone orchiectomy, and patients with lower RI were hospitalized and did not require surgery.…”

Testicular Torsion with Intact Blood Flow: A Point of Care Ultrasound Case-Series

“…In a case of testicular torsion, arterial flow will be decreased compared with the unaffected testis. This can result in absent or reversed waveforms as edema impedes or reverses forward flow; absence of a dicrotic notch resulting in a monophasic waveform (absence of diastolic flow between systolic peaks); or high amplitude waveforms indicating increasing resistance to flow (Figures 1,2) 6 , 7 . Conversely, arterial waveform may show a ‘tardus parvus’ pattern with low amplitude and slow upstroke, as seen in stenotic vessels (Figure 3) 8 .…”

Case report of rare chronic myelogenous leukemia related multibacterial splenic abscess presenting with scrotal swelling

“…Venous congestion has been demonstrated in ultrasound studies of scrotal swelling. 7 Epididymitis can occlude venous outflow 8 further exacerbating the scrotal swelling. In a similar case report, an 18-year-old male who presented with splenomegaly, scrotal swelling, and epididymitis was diagnosed with brucellosis.…”