Inguinoscrotal Pathology on Computed Tomography: An Alternative Perspective

A pictorial review of scrotal and penile pathology on computed tomography

Computed tomography (CT) may show a variety of scrotal and penile pathologic finding, but is usually not used as a first-line imaging due to its limited soft tissue contrast. Nonetheless, there are three main scenarios for imaging of the scrotum and penis with CT. Pathologies may be found incidentally in patients undergoing abdominal and pelvic CT scanning for different reasons. In emergency settings, CT is frequently performed, and the recognition of scrotal and penile pathologies by the reporting radiologist is crucial to ensure optimal patient treatment and outcome. If MRI scanning cannot be performed due to contraindications or is unavailable in resource, limited CT may be used for the further characterization of scrotal and penile pathology found on ultrasound. This pictorial review wants to familiarize general and emergency radiologists with the anatomy and possible pathological findings of the scrotum and penis on CT.

Visualizing the early-stage testicular torsion by dual-modal photoacoustic and ultrasound imaging

Delayed treatment of testicular torsion (TT) can lead to permanent loss of reproductive capacity. Photoacoustic imaging (PAI) and ultrasound imaging (USI) was tested for detecting TT at early stage in mice based on PAI-obtained oxygen saturation (sO₂), and USI-collected color pixel density (CPD), peak systolic velocity (PSV) and resistance index (RI). For complete TT, both CPD (9.08 % ± 3.084 to almost zero) and sO₂ data (70.09 % ± 1.656-59.84 % ± 1.427) showed an significant change 2 h post-torsion. For incomplete TT, sO₂ data exhibited a strong time relationship (Mean values: 6 h, 64.83 % ± 1.898; 12 h, 60.67 % ± 3.555; 24 h, 57.85 % ± 3.575; P < 0.05). However, USI-collected CPD, PSV or IR data from the same TT models showed no significant difference. This study indicated that USI and PAI could identify complete TT. Meanwhile, PAI has shown great potential in the diagnosis of incomplete TT within 24 h based on time-related sO₂ map.

Testicular Torsion Appearance and Diagnosis on Computed Tomography of the Abdomen/Pelvis: Case Report

Introduction: Testicular torsion, or the twisting of the spermatic cord compromising blood flow to the testis, is a urologic emergency with the potential to cause infertility in male patients. The diagnosis may be clinical or confirmed using imaging, with ultrasound being the modality of choice. Case Report: We present a case of right lower quadrant pain with radiation to the groin and right scrotum in a young male. A computed tomography of the abdomen and pelvis was ordered to assess for appendicitis, which showed a “whirl” sign on the inferior periphery of the images near the scrotum. The finding was not appreciated during the emergency department visit and the patient was discharged home. He returned 48 hours later due to continued pain and was ultimately diagnosed with testicular torsion via ultrasound and surgical pathology. Conclusion: This is the first reported case to our knowledge identifying “whirl” sign for the diagnosis of testicular torsion. This finding was not appreciated by multiple clinicians during the initial patient presentation, highlighting the uncommon nature of the finding.