Role of ultrasound with color Doppler in acute scrotum management

Abstract

Background and objective: An acute scrotum is defined as acute pain with or without scrotal swelling, may be accompanied by local signs or general symptoms. Acute scrotal pain is a medical emergency. Depending on cause, the management is entirely different. Torsion of testis and strangulated hernia are surgical emergency; whereas, epididymo-orchitis is treated by medicines. Testicular trauma and obstructed hernia can be differentiated by taking history from patient. Physical examination adds only a little information. Color Doppler ultrasound (US) is the modality of choice to differentiate testicular torsion from inflammatory conditions and can thus help in avoiding unnecessary surgical explorations.

Subjects and methods: A study on 50 patients was conducted who were referred with history of acute scrotal pain to our department between January 2013 and January 2014. Trauma and scrotal mass were excluded from the study. The clinical presentation, outcome, and US results were analyzed.

Results: Color Doppler sonography yielded a positive and negative predictive value (PPV and NPV) of 100% each for torsion, whereas, 93.9 and 70.6% for epididymo-orchitis, respectively; a sensitivity and specificity of 100% for torsion, whereas, for epididymo-orchitis it was found to be 86.1 and 85.7%, respectively. In cases of incomplete or early torsion, some residual perfusion may be detected leading to false-negative results.

Conclusion: We therefore conclude that color Doppler sonography can reliably rule out testicular torsion and can thus help in avoiding unnecessary surgical explorations. Hence, it can significantly improve outcome and decrease morbidity of patient. It is an accurate, rapid, nonexpensive, nonionizing, important adjunct to clinical assessment of scrotum.

Keywords: Color Doppler in acute scrotum; sonographic evaluation of acute scrotum; torsion of testis.

Figure 1

(a) Testis enlarged and appears heterogeneously hypoechoic. (b) Complete absence of detectable flow in the symptomatic testis. (c) Intrascrotal portion of the cord appears as edematous, round, ovoid, or curled echogenic extra testicular mass; with the epididymal head wrapped around it. (d) Whirlpool sign - color Doppler (CD) shows spiral twisting of vessels (arrow) proximal to the torsion knot

Figure 2

(a) Grey scale shows enlarged heterogeneously hypoechoic left epididymis with reactive hydrocele and associated thickenedspermatic cord/funiculitis is seen. (b) On CD, shows increased vascularity in left epididymis, and its adjoining spermatic cord