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Abstract
The paratesticular scrotal contents consist of the spermatic cord, epididymis, and fascia, which originate from the embryologic descent of the testis through the abdominal wall. Historically, the primary diagnostic modality has been high-resolution ultrasound. Magnetic resonance imaging (MRI) is an alternative imaging option. Both contrast MRI and diffusion weighted imaging can assist in differentiating between benign and malignant lesions. Unlike the testis which most disease processes are malignant, a wide spectrum of benign disease processes affects the paratesticular region either in isolation or as part of a contiguous disease process from adjacent organs. The familiarity with the epidemiology, pathogenesis, and imaging features can aid the radiologic diagnoses and guide appropriate clinical management. In this article, we review the ultrasound and MR characteristics of various paratesticular pathologies.
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52
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Amadife N, Pawley B. Core curriculum illustration: pediatric testicular torsion. Emerg Radiol 2016; 23:633-635. [PMID: 27744569 DOI: 10.1007/s10140-016-1451-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2016] [Accepted: 09/30/2016] [Indexed: 11/24/2022]
Abstract
This is the 21st installment of a series that will highlight one case per publication issue from the bank of cases available online as part of the American Society of Emergency Radiology (ASER) educational resources. Our goal is to generate more interest in and use of our online materials. To view more cases online please visit the ASER Core Curriculum and Recommendations for Study online at: http://www.erad.org/?page=CCIP_TOC .
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Affiliation(s)
- Nneka Amadife
- Department of Radiology, University of Kentucky, 800 Rose Street, Room HX 313E, Lexington, KY, 40356-0293, USA
| | - Barbara Pawley
- Department of Radiology, University of Kentucky, 800 Rose Street, Room HX 313E, Lexington, KY, 40356-0293, USA.
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53
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Fenton LZ, Karakas SP, Baskin L, Campbell JB. Sonography of pediatric blunt scrotal trauma: what the pediatric urologist wants to know. Pediatr Radiol 2016; 46:1049-58. [PMID: 27112160 DOI: 10.1007/s00247-016-3600-4] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/18/2015] [Revised: 02/02/2016] [Accepted: 02/25/2016] [Indexed: 11/28/2022]
Abstract
Pediatric blunt scrotal trauma is most often the consequence of sports injury and presents a diagnostic challenge because swelling and pain make a scrotal physical exam difficult. US with color flow and duplex Doppler is the first-line imaging modality with the goal of accurate and timely diagnosis of injury requiring surgery to preserve fertility and hormonal function. US imaging findings following blunt scrotal trauma include hydrocele, hematocele, testicular hematoma, testicular fracture, testicular rupture, compromised perfusion/testicular torsion and testicular dislocation. Importantly, several of these findings may coexist. Our goal is to present the pertinent intrascrotal anatomy, US imaging findings for each testicular injury, and contemporary management for each, with emphasis on what our pediatric urology colleagues need to know for optimal patient care.
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Affiliation(s)
- Laura Z Fenton
- Department of Pediatric Radiology, Children's Hospital Colorado, affiliated with the University of Colorado School of Medicine, 13123 East 16th Ave., B125, Aurora, CO, 80045, USA.
| | - S Pinar Karakas
- Department of Radiology, UCSF Benioff Children's Hospital, Oakland, CA, USA
| | - Laurence Baskin
- Department of Pediatric Urology, UCSF Benioff Children's Hospital, San Francisco, CA, USA
| | - Jeffrey B Campbell
- Department of Pediatric Urology, Children's Hospital Colorado, affiliated with the University of Colorado School of Medicine, Aurora, CO, USA
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54
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Daimiel Naranjo I, Alcalá-Galiano Rubio A. Inguinoscrotal Pathology on Computed Tomography: An Alternative Perspective. Can Assoc Radiol J 2016; 67:225-33. [PMID: 27221696 DOI: 10.1016/j.carj.2015.11.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2015] [Revised: 11/21/2015] [Accepted: 11/27/2015] [Indexed: 11/24/2022] Open
Abstract
Computed tomography (CT) is not the imaging technique of choice to assess inguinoscrotal pathology, as magnetic resonance or ultrasonography have superior soft tissue contrast resolution and do not involve gonadal exposure to ionizing radiation. However, testicular and inguinoscrotal pathology may be found both as an extension of intra-abdominal processes or incidentally on CT scans requested for other reasons. CT also plays a role in the evaluation of testicular injury when associated to pelvic trauma and in perineal infections with scrotal extension. A pictorial review of testicular and inguinoscrotal involvement in vascular, neoplastic, traumatic, infectious, or inflammatory diseases and in complications of abdominal surgeries is presented. Additionally, the CT appearance of several congenital anomalies and benign processes is depicted.
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55
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Abstract
This review article illustrates sonographic findings in the setting of accidental and nonaccidental scrotal trauma. Although sonographic findings may be irrespective of the type of trauma, the goals of sonographic evaluation are similar in both atypical and typical mechanisms of scrotal injury. Familiarity with findings such as disruption of testicular integrity or vascularity facilitates prompt diagnosis and plays a critical role in clinical management.
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56
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Abstract
Lower genitourinary tract trauma comprises a substantial portion of the trauma burden in the USA. Some key trends and findings are described. Mortality is relatively high in patients with bladder trauma due to associated injuries. Urethral injuries should be suspected in patients presenting with the triad of blood at the urethral meatus, suprapubic fullness indicative of a full bladder, and urinary retention. Urethral injury is common in penetrating penile trauma, and stab wounds to the penis are more likely to involve the urethra than gunshot wounds. Penile fracture is largely a clinical diagnosis and suspicion of fracture requires urgent surgical exploration. Zipper injuries are the most common cause of presentation to the emergency department for penile trauma in adults. Toilet seat injuries are the leading cause of penile pediatric trauma presenting to the emergency department. In the setting of testicular trauma, rates of testicular salvage are excellent when exploration is prompt. Trauma in the form of animal or human bites requires treatment with broad-spectrum antibiotics in addition to repair of the injury. Military trauma has seen an increase in explosive injuries to the lower urinary tracts due to evolution of warfare tactics. Increasing awareness of presentation and context of lower genitourinary tract trauma can reduce delay of diagnosis and morbidity associated with such injuries.
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Affiliation(s)
- David Bayne
- Department of Urology, University of California, San Francisco, CA, USA
| | - Uwais Zaid
- Department of Urology, University of California, San Francisco, CA, USA
| | - Amjad Alwaal
- Department of Urology, University of California, San Francisco, CA, USA
| | - Catherine Harris
- Department of Urology, University of California, San Francisco, CA, USA
| | - Jack McAninch
- Department of Urology, University of California, San Francisco, CA, USA
| | - Benjamin Breyer
- Department of Urology, University of California, San Francisco, CA, USA
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57
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Kannikeswaran N, Shah A, Fichadia U, Arora R. A Kick in the Groin. Clin Pediatr (Phila) 2015; 54:1113-6. [PMID: 25520368 DOI: 10.1177/0009922814563274] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
| | - Ami Shah
- Children's Hospital of Michigan, Detroit, MI, USA
| | | | - Rajan Arora
- Children's Hospital of Michigan, Detroit, MI, USA
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58
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Yusuf G, Konstantatou E, Sellars ME, Huang DY, Sidhu PS. Multiparametric Sonography of Testicular Hematomas: Features on Grayscale, Color Doppler, and Contrast-Enhanced Sonography and Strain Elastography. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2015; 34:1319-1328. [PMID: 26112637 DOI: 10.7863/ultra.34.7.1319] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
We investigated the appearances of intratesticular hematomas on multiparametric sonography combining grayscale, color Doppler, and contrast-enhanced sonography and strain elastography. Over a 3-year period, 17 hematomas in 8 patients were analyzed. Blunt trauma (n = 7) and surgery (n = 1) were preceding events. Grayscale sonography showed well-defined oval or round predominantly hypoechoic and heterogeneous, peripherally (n = 13) or centrally (n = 4) located lesions. Three showed contrast enhancement of septations, and 4 showed peripheral lesion rim enhancement. On strain elastography, the mean strain ratio was 1.19 (range, 0.41-2.36), and elasticity score were 3 or lower (n = 13) and 5 (n = 4). Multiparametric sonography shows nonenhancement with contrast and predominantly "soft" elastographic properties and aids in the interpretation of the benign nature of intratesticular hematomas.
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Affiliation(s)
- Gibran Yusuf
- Department of Radiology, King's College Hospital, King's College London, London, England
| | - Eleni Konstantatou
- Department of Radiology, King's College Hospital, King's College London, London, England
| | - Maria E Sellars
- Department of Radiology, King's College Hospital, King's College London, London, England
| | - Dean Y Huang
- Department of Radiology, King's College Hospital, King's College London, London, England
| | - Paul S Sidhu
- Department of Radiology, King's College Hospital, King's College London, London, England.
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59
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Tsili AC, Giannakis D, Sylakos A, Ntorkou A, Sofikitis N, Argyropoulou MI. MR imaging of scrotum. Magn Reson Imaging Clin N Am 2015; 22:217-38, vi. [PMID: 24792679 DOI: 10.1016/j.mric.2014.01.007] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Magnetic resonance (MR) imaging of the scrotum has been used as a valuable supplemental diagnostic modality in evaluating scrotal pathology, mostly recommended in cases of inconclusive sonographic findings. Because of the advantages of the technique, MR imaging of the scrotum may provide valuable information in the detection and characterization of various scrotal diseases. The technique may accurately differentiate intratesticular from extratesticular mass lesions and provide important information in the preoperative characterization of the histologic nature of scrotal masses. An accurate estimation of the local extent of testicular carcinomas in patients for whom testis-sparing surgery is planned is possible.
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Affiliation(s)
- Athina C Tsili
- Department of Clinical Radiology, Medical School, University of Ioannina, Ioannina 45110, Greece.
| | - Dimitrios Giannakis
- Department of Urology, Medical School, University of Ioannina, Ioannina 45110, Greece
| | - Anastasios Sylakos
- Department of Urology, Medical School, University of Ioannina, Ioannina 45110, Greece
| | - Alexandra Ntorkou
- Department of Clinical Radiology, University Hospital of Ioannina, Leoforos S. Niarchou, Ioannina 45500, Greece
| | - Nikolaos Sofikitis
- Department of Urology, Medical School, University of Ioannina, Ioannina 45110, Greece
| | - Maria I Argyropoulou
- Department of Clinical Radiology, Medical School, University of Ioannina, Ioannina 45110, Greece
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60
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Coleman S, Goel R, Park E, Rhee A. Acute Testicular Fracture. J Urol 2014; 192:1525-6. [DOI: 10.1016/j.juro.2014.08.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/04/2014] [Indexed: 10/24/2022]
Affiliation(s)
- Sarah Coleman
- Glickman Institute, Cleveland Clinic, Cleveland, Ohio
| | - Rakhee Goel
- Glickman Institute, Cleveland Clinic, Cleveland, Ohio
| | - Ellen Park
- Glickman Institute, Cleveland Clinic, Cleveland, Ohio
| | - Audrey Rhee
- Glickman Institute, Cleveland Clinic, Cleveland, Ohio
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61
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Adlan T, Freeman SJ. Can ultrasound help to manage patients with scrotal trauma? ULTRASOUND : JOURNAL OF THE BRITISH MEDICAL ULTRASOUND SOCIETY 2014; 22:205-12. [PMID: 27433221 DOI: 10.1177/1742271x14545911] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Traumatic injuries to the scrotum are uncommon but, when they do occur, frequently lead to serious complications. Early complications include testicular infarction, necrosis and abscess formation; in the longer-term trauma may result in testicular atrophy and subfertility. Early surgical intervention in patients with testicular rupture can significantly improve the clinical outcome and reduce the need for delayed orchidectomy. However, clinical examination of the scrotum following trauma is difficult and frequently inaccurate; this may result in incorrect triage of patients for surgical exploration. Scrotal ultrasound can reliably assess scrotal injuries and diagnose testicular rupture with a high level of accuracy. Additionally, ultrasound can provide important information regarding testicular perfusion, which can further inform decisions on surgical management. This article reviews the sonographic findings that may be encountered in patients with scrotal trauma, with an emphasis on blunt trauma. It describes the pivotal role that ultrasound can play in the accurate triage of these patients to surgical or conservative management.
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Affiliation(s)
- T Adlan
- Imaging Directorate, Derriford Hospital, Plymouth, UK
| | - S J Freeman
- Imaging Directorate, Derriford Hospital, Plymouth, UK
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62
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Abstract
OBJECTIVE The purpose of this article is to review scrotal and penile anatomy, the role of ultrasound in evaluating scrotal and penile trauma, and the vast spectrum of sonographic manifestations of scrotal and penile trauma. CONCLUSION Scrotal and penile trauma is an uncommon type of trauma injury. However, knowledge of scrotal and penile anatomy and the appropriate imaging findings associated with acute traumatic injuries is important in establishing the correct diagnosis. Sonography is considered the first choice of imaging modalities in establishing a diagnosis and triaging patients into surgical and nonsurgical treatment.
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63
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Resende DDAQP, Souza LRMFD, Monteiro IDO, Caldas MHDS. Scrotal collections: pictorial essay correlating sonographic with magnetic resonance imaging findings. Radiol Bras 2014. [DOI: 10.1590/s0100-39842014000100014] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
The present study is aimed at describing scrotal collections observed at ultrasonography and magnetic resonance imaging. The authors describe the main features of hydrocele, hematocele and pyocele, as well as the most common causes, clinical manifestations and associated diseases, with a brief review of the embryology and anatomy of the scrotum. Collections are frequently found in the evaluation of the scrotum, which is often performed on an emergency basis, and in most cases can be differentiated by means of imaging studies. With the consolidation of magnetic resonance imaging as the method of choice complementary with ultrasonography, the authors also describe magnetic resonance imaging findings of scrotal collections as well as the situations where such method is indicated.
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64
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A review of ultrasound imaging in scrotal emergencies. J Ultrasound 2013; 16:171-8. [PMID: 24432171 DOI: 10.1007/s40477-013-0033-x] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2013] [Accepted: 08/01/2013] [Indexed: 02/01/2023] Open
Abstract
Scrotal emergencies represent a small proportion of admissions to the emergency department; however, the intimate nature and potential for serious outcome often cause great anxiety. Rapid assessment is required to exclude fertility-threatening conditions and expedite surgical management. Ultrasound is an essential tool in acute scrotal assessment as it allows rapid, radiation-free, high-resolution imaging and, importantly, assessment of vascularity with colour Doppler imaging. In the presentation of the acute scrotum, the "on-call" practitioner will frequently be asked to exclude pathology requiring surgical management, in particular torsion of the spermatic cord. To provide an accurate evaluation the individual is required to have an understanding of scrotal anatomy, sonographic technique and recognition of pathology. This review article will familiarise the reader with the sonographic findings of common acute scrotal pathology.
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65
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66
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67
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Abstract
Imaging of the genitourinary tract is essential in the workup of the majority of the conditions seen daily by urologists. The use of ultrasound in the office provides a safe, low cost, and efficient way for the clinician to evaluate the patient in real time. Ultrasound can allow for bedside diagnosis in many conditions and assist in treatment planning. This chapter covers the major applications of office ultrasound for the urologist as well as discusses future applications of ultrasound for the office setting.
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Affiliation(s)
- Etai Goldenberg
- Hofstra North Shore-LIJ School of Medicine, The Arthur Smith Institute for Urology, New Hyde Park, NY 11042, USA.
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68
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69
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MILES G, FREEMAN SJ. Ultrasound imaging of the “on call” acute scrotum. IMAGING 2013. [DOI: 10.1259/imaging.20120025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
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70
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Abstract
Male genital trauma is a rare but potentially serious sports injury. Although such an injury can occur by many different mechanisms, including falls, collisions, straddle injuries, kicks, and equipment malfunction, the clinical presentation is typically homogeneous, characterized by pain and swelling. Almost all sports-related male genital injury comes from blunt force trauma, with involvement of scrotal structures far more common than penile structures. Most injuries can be treated conservatively, but catastrophic testicular injury must first be ruled out. Despite being relatively uncommon compared with other sports injuries, more than half of all testicular injuries are sustained during sports.
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Affiliation(s)
- Stanley R Hunter
- Milton Family Practice, Department of Family Medicine, University of Vermont College of Medicine, Burlington, VT 05401, USA
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71
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De Zordo T, Stronegger D, Pallwein-Prettner L, Harvey CJ, Pinggera G, Jaschke W, Aigner F, Frauscher F. Multiparametric ultrasonography of the testicles. Nat Rev Urol 2013; 10:135-48. [DOI: 10.1038/nrurol.2012.255] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
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72
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73
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74
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Hebert SC, Chong WK, Deurdulian C. Essentials of scrotal ultrasound: A review of frequently encountered abnormalities. APPLIED RADIOLOGY 2012. [DOI: 10.37549/ar1932] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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75
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Emergency testicular sperm extraction after scrotal trauma in a patient with a history of contralateral orchiopexy for cryptorchidism: case report and review of the literature. Fertil Steril 2012; 97:1074-7. [DOI: 10.1016/j.fertnstert.2012.02.017] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2011] [Revised: 02/15/2012] [Accepted: 02/15/2012] [Indexed: 11/18/2022]
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76
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Sonography of the Pediatric Scrotum: Emphasis on the Ts—Torsion, Trauma, and Tumors. AJR Am J Roentgenol 2012; 198:996-1003. [DOI: 10.2214/ajr.11.8034] [Citation(s) in RCA: 65] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
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77
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Rowell RM, Rylander SJ. Low-Back Pain, Leg Pain, and Chronic Idiopathic Testicular Pain Treated with Chiropractic Care. J Altern Complement Med 2012; 18:420-2. [DOI: 10.1089/acm.2010.0698] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Robert M. Rowell
- Diagnosis and Radiology Department, Palmer College of Chiropractic, Davenport, Davenport, IA
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78
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79
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AIUM practice guideline for the performance of an ultrasound examination in the practice of urology. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2012; 31:133-144. [PMID: 22215782 DOI: 10.7863/jum.2012.31.1.133] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
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80
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Bonardi M, Dellabianca C, Alessi S. Post-traumatic hematoma of the epididymis: Case-report. J Ultrasound 2011; 14:196-8. [PMID: 23396685 DOI: 10.1016/j.jus.2011.09.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022] Open
Abstract
Scrotal trauma accounts for less than 1% of all trauma-related injuries. Traumatic injuries of the epididymis are extremely rare.Here we report a rare case of hematoma of the epididymis, diagnosed with US, in a 10-year-old boy after a sport injury.
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Affiliation(s)
- M Bonardi
- IRCCS Foundation, San Matteo Medical Center, Institute of Radiology, University of Pavia, Italy
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81
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Lobianco R, Regine R, De Siero M, Catalano O, Caiazzo C, Ragozzino A. Contrast-enhanced sonography in blunt scrotal trauma(). J Ultrasound 2011; 14:188-95. [PMID: 23396988 DOI: 10.1016/j.jus.2011.09.003] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
The scope of this study was to determine whether contrast-enhanced ultrasonography (CEUS), compared with basic US, can increase diagnostic confidence and provide relevant information on blunt scrotal trauma. Over a period of 75 months we examined 40 patients seen consecutively for blunt scrotal trauma using high-resolution US, color-power Doppler, low mechanical index CEUS, and power Doppler after IV administration of contrast medium (SonoVue(®)). In the 24 cases that were positive, concordance between basal US and CEUS findings was grade 0 (absent) in 4 cases, grade 1 (low) in 3, grade 2 (moderate) in 8, and grade 3 (high) in 9. The relevance of the additional information provided by CEUS was classified as follows: high in 4/40 (10%), moderate 7/40 (17,5%), low 13/40 (32,5%), none in 14/40 (35%). Our findings demonstrate that CEUS is appreciably more sensitive in detecting damage caused by blunt scrotal trauma, particularly small lesions. It is also useful for differential diagnosis and marginalization of corpuscular fluid collections, fractures, and above all ruptures, which require immediate surgery. In our series 2 out of 3 (67%) patients with testicular rupture were diagnosed only by CEUS. We feel that the use of CEUS can significantly improve diagnostic confidence in cases of closed scrotal trauma although these conclusions need to be confirmed in larger case series.
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Affiliation(s)
- R Lobianco
- Radiology Department, Santa Maria delle Grazie Hospital, Pozzuoli, Naples, Italy
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82
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Imaging features of benign solid testicular and paratesticular lesions. Eur Radiol 2011; 21:2226-34. [PMID: 21626362 DOI: 10.1007/s00330-011-2155-x] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2011] [Revised: 03/26/2011] [Accepted: 04/26/2011] [Indexed: 01/08/2023]
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83
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Role of US in acute scrotal pain. World J Urol 2011; 29:639-43. [DOI: 10.1007/s00345-011-0698-8] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2011] [Accepted: 05/05/2011] [Indexed: 11/26/2022] Open
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84
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Cokkinos DD, Antypa E, Tserotas P, Kratimenou E, Kyratzi E, Deligiannis I, Kachrimanis G, Piperopoulos PN. Emergency Ultrasound of the Scrotum: A Review of the Commonest Pathologic Conditions. Curr Probl Diagn Radiol 2011; 40:1-14. [DOI: 10.1067/j.cpradiol.2009.07.011] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
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85
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AIUM practice guideline for the performance of scrotal ultrasound examinations. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2011; 30:151-155. [PMID: 21193719 DOI: 10.7863/jum.2011.30.1.151] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
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86
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Abstract
Abstract
Purpose
The purpose of this article is to provide a practical review of common ultrasound (US) findings in patients presenting with acute scrotal pain.
Methods
We performed a literature search and reviewed numerous US cases archived in the radiology department of a large university hospital to find examples that illustrate the common US findings encountered in acute scrotal pain.
Results
We reviewed the literature and provided several practical examples of common US findings in patients presenting with acute scrotal pain.
Conclusion
Scrotal US plays a pivotal role in the evaluation of acute scrotal pain and allows proper triage of patients for conservative, medical, or surgical management due to its ability to rapidly differentiate intra versus extratesticular pathology, determine extent of trauma, and assess parenchymal perfusion.
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87
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Lardellier F, Varlet F, François M, Audry G, Buisson P, Dubois R, Galinier P, Geiss S, Gorduza D, Kalfa N, Lacreuse I, Leclair MD, Merrot T, Paye-Jaouen A, Ravasse P, Sapin E, Teklali Y, Valla JS, Diraduryan N, Guye E, Lopez M. Traumatisme du testicule chez l’enfant. Basic Clin Androl 2010. [DOI: 10.1007/s12610-010-0097-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Abstract
Résumé
Introduction
Les traumatismes du testicule sont rares chez l’enfant, et la littérature est très pauvre sur ce sujet. Le but était de les analyser à partir d’une étude multicentrique rétrospective.
Matériel et méthodes
Un questionnaire sur les traumatismes du testicule survenus entre 2000 et 2009 a été envoyé dans les différents centres de chirurgie pédiatrique français. L’analyse a été effectuée à l’aide du questionnaire et du compte rendu opératoire, et n’ont été retenus que les dossiers de traumatisme vrai du testicule, excluant les plaies simples du scrotum, les traumatismes « révélateurs » d’une torsion de testicule ou d’hydatide, ou encore les dossiers incomplets.
Résultats
Quinze centres ont bien voulu nous transmettre leurs observations et parmi ceux-ci, deux ont répondu n’avoir opéré aucun cas; cette étude n’est pas exhaustive, car beaucoup d’équipes ont envoyé des dossiers d’enfants opérés et aucun cas de traumatisme bénin. Parmi les 60 observations reçues, 45 ont été retenues. L’âge moyen était de 12,3 ans (2 jours–18 ans). Les circonstances du traumatisme étaient 23 coups (pied, genou, poing), 13 chutes (vélo, banc, luge), quatre accidents de la voie publique, quatre traumatismes de nature inconnue et un traumatisme obstétrical. Le traumatisme était fermé 41 fois et ouvert quatre fois. L’échographie-doppler couleur a été réalisée dans 34 cas sur 45 (75,5 %); un diagnostic exact a été possible 30 fois, alors qu’il y a eu trois faux-positifs (deux fractures du testicule et un hématome intratesticulaire non confirmés à l’intervention) et un faux-négatif (contusion de l’épididyme non vue à l’échographie). Les lésions testiculaires étaient les suivantes: 15 fractures, huit hématomes intratesticulaires, six contusions testiculaires bénignes (dont une associée à une tumeur), six hématomes du cordon, six contusions de l’épididyme, trois hématocèles isolées et une avulsion. Le traitement a été chirurgical 33 fois et non opératoire 12 fois. Parmi les 15 fractures du testicule, 13 ont été opérées (huit sutures et cinq orchidectomies partielles) et deux ont été surveillées avec de bons résultats, sans atrophie secondaire. Pour les hématomes intratesticulaires, trois ont été surveillés et cinq opérés. Seuls 20 enfants ont été suivis au-delà de quatre mois, essentiellement les fractures testiculaires, et aucune atrophie secondaire n’a été constatée.
Conclusion
Les traumatismes du testicule chez l’enfant sont rares, mais leur pronostic est plutôt bon. L’échographie-doppler permet désormais de faire un diagnostic précis dans un grand nombre de cas, devant permettre d’éviter certaines explorations chirurgicales systématiques; mais l’intervention reste indispensable en cas de doute.
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Abstract
Color Doppler USG of the scrotum has been demonstrated to be useful in the diagnosis of scrotal lesions. Gray-scale USG characterizes the lesions as testicular or extratesticular and, with color Doppler and power Doppler, flow and perfusion can also be assessed. Color Doppler is particularly helpful in acute painful conditions, where it can differentiate testicular ischemia from inflammatory conditions and thus prevent unnecessary surgical explorations. With color Doppler, useful information can be gained about vascularity in testicular malignancies. Color Doppler also has high sensitivity and high specificity in the diagnosis of lesions like varicoceles.
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Affiliation(s)
- Bhardwaj Patiala
- Department of Radiodiagnosis, Govt. Medical College and Rajindra Hospital, Patiala, India
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