Abstract
The majority of cases of acute scrotum are due to one of these three causes: trauma, torsion and inflammation.
Acute scrotum syndrome of any origin always merits immediate evaluation to prevent testicular function and chronic irreversible complication.
Correct differential diagnoses between these conditions are mandatory because uncorrected diagnosis could lead to catastrophic consequence.
Often physical examination is not sufficient to avoid suspicious conditions that require surgical correction and then imaging.
High-resolution ultrasound is the imaging modality of choice for the examination of superficially located scrotal sac and its contents. Greyscale ultrasonography in combination with colour or power Doppler imaging is a well-accepted technique for assessing scrotal lesions and testicular perfusion.
In this chapter, clinical features, greyscale and colour Doppler US appearance of testicular torsion, trauma and inflammation are described.
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References
Burgher SW (1998) Acute scrotal pain. Emerg Med Clin North Am 16:781–809
Dogra VS, Bhatt S, Rubens DJ (2006) Sonographic evaluation of testicular torsion. Ultrasound Clin 1:55–66
Wilbert DM, Schaerfe CW, Stern WD et al (1993) Evaluation of the acute scrotum by color-coded Doppler ultrasonography. J Urol 149:1475–1477
Lin EP, Bhatt S, Rubens DJ et al (2007) Testicular torsion: twists and turns. Semin Ultrasound CT MRI 28:317–328
Favorito LA, Cavalcante AG, Costa WS (2004) Anatomic aspects of epididymis and tunica vaginalis in patients with testicular torsion. Int Braz J Urol 30:420–424
Dogra V (2003) Bell-clapper deformity. Am J Roentgenol 180:1176–1177
Hricak H, Lue T, Filly RA, Alpers CE, Zeineh SJ, Tanagho EA (1983) Experimental study of the sonographic diagnosis of testicular torsion. J Ultrasound Med 2(8):349–56
Kadish HA, Bolfe RG (1998) A retrospective review of pediatric patients with epididymitis, testicular torsion, and torsion of testicular appendages. Pediatrics 102:73–76
Kass EJ, Lundak B (1997) The acute scrotum. Pediatr Clin North Am 44:1251–1266
Middleton WD, Middleton MA, Dierks M et al (1997) Sonographic prediction of viability in testicular torsion: preliminary observations. J Ultrasound Med 16:23–27
Vijayaraghavan SB (2006) Sonographic differential diagnosis of acute scrotum: real-time whirlpool sign, a key sign of torsion. J Ultrasound Med 25:563–574
Siegel MJ (1997) The acute scrotum. Radiol Clin North Am 674(35):959–976
Snyder HM, Diamond DA (2010) In utero/neonatal torsion: observation versus prompt exploration. J Urol 183:1675–1677
Haas CA, Brown SL, Spirnak JP (1999) Penile fracture and testicular rupture. World J Urol 17:101–106
Buckley JC, McAninch JW (2006) Diagnosis and management of testicular ruptures. Urol Clin North Am 33:111–116, vii
Gross M (1969) Rupture of the testicle: the importance of early surgical treatment. J Urol 101:196–197
Guichard G, El Ammari J, Del Coro C et al (2008) Accuracy of ultrasonography in diagnosis of testicular rupture after blunt scrotal trauma. Urology 71:52–56
Kim SH, Park S, Choi SH et al (2007) Significant predictors for determination of testicular rupture on sonography: a prospective study. J Ultrasound Med 26:1649–1655
Moschouris H, Stamatiou K, Lampropoulou E et al (2009) Imaging of the acute scrotum: is there a place for contrast- enhanced ultrasonography? Int Braz J Urol 35:692–702; discussion 702–695
Deurdulian C, Mittelstaedt CA, Chong WK et al (2007) US of acute scrotal trauma: optimal technique, imaging findings, and management. Radiographics 27:357–369
Bhatt S, Dogra VS (2008) Role of US in testicular and scrotal trauma. Radiographics 28:1617–1629
Yagil Y, Naroditsky I, Milhem J et al (2010) Role of Doppler ultrasonography in the triage of acute scrotum in the emergency department. J Ultrasound Med 29:11–21
Naber KG, Weidner W (1999) Prostatitis, epididymitis, orchitis. In: Armstrong D, Cohen J (eds) Infectious diseases. Mosby. Harcourt Publishers Ltd, London, pp 1–58
Cook JL, Dewbury K (2000) The changes seen on high-resolution ultrasound in orchitis. Clin Radiol 55:13–18
Casalino DD, Kim R (2002) Clinical importance of a unilateral striated pattern seen on sonography of the testicle. AJR Am J Roentgenol 178:927–930
Sidhu PS (1999) Clinical and imaging features of testicular torsion: role of ultrasound. Clin Radiol 54:343–352
Ruibal M, Quintana JL, Fernandez G et al (2003) Segmental testicular infarction. J Urol 170:187–188
Bird K, Rosenfield AT (1984) Testicular infarction secondary to acute inflammatory disease: demonstration by B-scan ultrasound. Radiology 152:785–788
Gofrit ON, Rund D, Shapiro A et al (1998) Segmental testicular infarction due to sickle cell disease. J Urol 160:835–836
Baer HM, Gerber WL, Kendall AR et al (1989) Segmental infarct of the testis due to hypersensitivity angiitis. J Urol 142:125–127
Braeckman P, Joniau S, Oyen R et al (2002) Polyarteritis nodosa mimicking a testis tumour: a case report and review of the literature. Cancer Imaging 2:96–98
Bilagi P, Sriprasad S, Clarke JL et al (2007) Clinical and ultrasound features of segmental testicular infarction: six-year experience from a single centre. Eur Radiol 17:2810–2818
Sriprasad S, Kooiman GG, Muir GH et al (2001) Acute segmental testicular infarction: differentiation from tumour using high frequency colour Doppler ultrasound. Br J Radiol 74:965–967
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Bucci, S., Rizzo, M., Liguori, G., Umari, P., Chiriacò, G., Bertolotto, M. (2017). The Testicles: Trauma, Inflammation and Testicular Torsion. In: Martino, P., Galosi, A. (eds) Atlas of Ultrasonography in Urology, Andrology, and Nephrology. Springer, Cham. https://doi.org/10.1007/978-3-319-40782-1_41
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