1
|
Kurian J, Winant AJ, Hull NC, Lee EY. Pediatric Acute Abdomen: Bread-and-Butter Diagnoses. Semin Roentgenol 2024; 59:312-331. [PMID: 38997184 DOI: 10.1053/j.ro.2024.02.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2024] [Accepted: 02/26/2024] [Indexed: 07/14/2024]
Affiliation(s)
- Jessica Kurian
- Department of Radiology, Westchester Medical Center, Valhalla, NY.
| | - Abbey J Winant
- Department of Radiology, Boston Children's Hospital and Harvard Medical School, Boston, MA
| | | | - Edward Y Lee
- Department of Radiology, Boston Children's Hospital and Harvard Medical School, Boston, MA
| |
Collapse
|
2
|
Hosokawa T, Tanami Y, Sato Y, Oguma E. Point-of-care ultrasonography for the diagnosis and manual detorsion of testicular torsion. J Med Ultrason (2001) 2024; 51:59-70. [PMID: 37863980 PMCID: PMC10937765 DOI: 10.1007/s10396-023-01374-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2023] [Accepted: 09/11/2023] [Indexed: 10/22/2023]
Abstract
Testicular torsion is a urological emergency caused by the loss of testicular tissue due to ischemic damage. Rapid diagnosis and urgent treatment play a crucial role in the management of testicular torsion. Manual detorsion can be performed at the bedside, thereby reducing the duration of ischemia. Recent studies have reported the use of point-of-care ultrasonography for diagnosing testicular torsion; however, no review article has focused on the ultrasonographic findings pertaining to manual detorsion. This review describes the diagnosis of testicular torsion and the ultrasonographic indications for manual detorsion. Spermatic cord twisting or the whirlpool sign, absence of or decreased blood flow within the affected testis, abnormal testicular axis, abnormal echogenicity, and enlargement of the affected testis and epididymis due to ischemia are the sonographic findings associated with testicular torsion. The following findings are considered indications for manual detorsion: direction of testicular torsion, i.e., inner or outer direction (ultrasonographic accuracy of 70%), and the degree of spermatic cord twist. The following sonographic findings are used to determine whether the treatment was successful: presence of the whirlpool sign and the degree and extent of perfusion of the affected testis. Misdiagnosis of the direction of manual detorsion, a high degree of spermatic cord twisting and insufficient detorsion, testicular compartment syndrome, and testicular necrosis were found to result in treatment failure. The success of manual detorsion is determined based on the symptoms and sonographic findings. Subsequent surgical exploration is recommended in all cases, regardless of the success of manual detorsion.
Collapse
Affiliation(s)
- Takahiro Hosokawa
- Department of Radiology, Saitama Children's Medical Center, 1-2 Shintoshin Chuo-ku Saitama, Saitama, 330-8777, Japan.
| | - Yutaka Tanami
- Department of Radiology, Saitama Children's Medical Center, 1-2 Shintoshin Chuo-ku Saitama, Saitama, 330-8777, Japan
| | - Yumiko Sato
- Department of Radiology, Saitama Children's Medical Center, 1-2 Shintoshin Chuo-ku Saitama, Saitama, 330-8777, Japan
| | - Eiji Oguma
- Department of Radiology, Saitama Children's Medical Center, 1-2 Shintoshin Chuo-ku Saitama, Saitama, 330-8777, Japan
| |
Collapse
|
3
|
Yadav P, Erlich T, Zlotnik M, Khondker A, O'Kelly F, Traubici J, Chua ME, Koyle MA. Ultrasonographical features of perinatal testicular torsion: an assessment of interobserver variability among radiologists and pediatric urologists. Pediatr Surg Int 2022; 38:2053-2058. [PMID: 36261731 DOI: 10.1007/s00383-022-05260-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/15/2022] [Indexed: 11/28/2022]
Abstract
PURPOSE To retrospectively compare interpretations of Doppler ultrasound (US) in newborns with confirmed perinatal testicular torsion (PTT) by an experienced faculty (staff) pediatric radiologist (SPR), pediatric radiology fellow (PRF), pediatric urology fellow (PUF) and staff pediatric urologist (SPU). METHODS US images of 27 consecutive males with PTT between May 2000 and July 2020 were retrieved. The testicles were classified as affected or non-affected by PTT. We performed a blinded comparison of interpretation by four assessors (SPR, PRF, PUF, SPU), with respect to the US features of PTT. Paired inter-rater agreement was calculated using Cohen's Kappa (κ) and overall agreement was assessed using Fleiss' kappa. RESULTS Overall comparison using Fleiss' kappa found fair agreement for most features except testicular echogenicity and echogenic foci at interface for which there was poor agreement. Paired comparisons revealed better agreement between the SPR and PRF compared to the remaining two pairs, suggesting a need for the pediatric urologists (PUF and SPU) to acquaint themselves with testicular ultrasonography as this may have an impact on patient risk stratification and the quality of information given to parents. CONCLUSION This study highlights the need for focused training program for pediatric urologists to attain similar agreement as the radiologists, suggesting a need for the pediatric urologists (PUF and SPU) to acquaint themselves with testicular ultrasonography as this may have an impact on patient risk stratification and the quality of information given to parents.
Collapse
Affiliation(s)
- Priyank Yadav
- Division of Urology, The Hospital for Sick Children, University of Toronto, Toronto, ON, Canada. .,Department of Urology and Renal Transplantation, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, India.
| | - Tomer Erlich
- Division of Urology, The Hospital for Sick Children, University of Toronto, Toronto, ON, Canada
| | - Margalit Zlotnik
- Division of Diagnostic Imaging, The Hospital for Sick Children, University of Toronto, Toronto, ON, Canada
| | - Adree Khondker
- Division of Urology, The Hospital for Sick Children, University of Toronto, Toronto, ON, Canada
| | - Fardod O'Kelly
- Division of Urology, The Hospital for Sick Children, University of Toronto, Toronto, ON, Canada.,Department of Pediatric Urology, Beacon Hospital, Dublin, and School of Medicine, University College Dublin, Dublin, Ireland
| | - Jeffrey Traubici
- Division of Diagnostic Imaging, The Hospital for Sick Children, University of Toronto, Toronto, ON, Canada
| | - Michael E Chua
- Division of Urology, The Hospital for Sick Children, University of Toronto, Toronto, ON, Canada.,Institute of Urology, St. Luke's Medical Center, Quezon City, Philippines
| | - Martin A Koyle
- Division of Urology, The Hospital for Sick Children, University of Toronto, Toronto, ON, Canada
| |
Collapse
|
4
|
Lee J, Kim Y, Jou S, Park C. [Inguinal and Scrotal Diseases in Children and Adolescents]. JOURNAL OF THE KOREAN SOCIETY OF RADIOLOGY 2022; 83:792-807. [PMID: 36238923 PMCID: PMC9514593 DOI: 10.3348/jksr.2021.0099] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/25/2021] [Revised: 09/03/2021] [Accepted: 09/30/2021] [Indexed: 11/15/2022]
Abstract
In children and adolescents, inguinal and scrotal diseases are relatively common, and imaging is very useful for the diagnosis and differential diagnosis of these diseases. Therefore, it is important to understand the imaging findings of these diseases. In this article, we classify these diseases into small testes, cryptorchidism, patent processus vaginalis, acute scrotum pain, trauma, testicular tumors, and others and describe their characteristic findings.
Collapse
|
5
|
Xu Z, Wu J, Ni S, Luo H. The diagnostic value of ultrasound in pediatric testicular torsion with preserved flow. Front Pediatr 2022; 10:1001958. [PMID: 36245726 PMCID: PMC9554414 DOI: 10.3389/fped.2022.1001958] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/24/2022] [Accepted: 09/07/2022] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Testicular torsion is the reduction of blood flow to the testis after spermatic cord torsion. For patients, the diagnosis of testicular torsion is controversial and complicated by the fact that ultrasound blood flow signals are not significantly reduced in comparison to the unaffected, healthy, testis, despite persistent symptoms on the affected side. Our study aims to investigate the diagnostic characteristics of high-resolution ultrasonography (US) in pediatric testicular torsion with the preserved flow to increase diagnostic accuracy. METHODS Seven pediatric patients aged 49 days to 15 years old, with the preserved blood flow, but surgically diagnosed as testicular torsion, from October 2017 to August 2019, were retrospectively included in the study. The imaging manifestations of high-frequency ultrasonography were evaluated. RESULTS All cases had preserved testicular blood flow, but the surgical findings showed various degrees of twist, from 90 to 540 degrees. Preoperative ultrasound showed spermatic cord distortion in all cases, and testicular long axis tilting in four cases (4/7 = 57.1%). CONCLUSION In some testicular torsion cases, Color Doppler may show normal or increased blood flow signals in the testis. We should further observe the morphology and position of the testes and epididymides, the echo of the testicular parenchyma, and, especially evaluate the "whirlpool sign" in the spermatic cord, to avoid missing testicular torsion with blood flow signals.
Collapse
Affiliation(s)
- Zhihua Xu
- Department of Ultrasonic Diagnosis, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, China
| | - Junbo Wu
- Department of Children's Ultrasound Imaging, Wuhan Children's Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Shuangshuang Ni
- Department of Ultrasonic Diagnosis, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, China
| | - Hongxia Luo
- Department of Ultrasonic Diagnosis, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, China
| |
Collapse
|
6
|
Kylat RI, Ahmed MN. Neonatal testicular torsion. Afr J Paediatr Surg 2022; 19:1-4. [PMID: 34916342 PMCID: PMC8759414 DOI: 10.4103/ajps.ajps_153_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Rotation of the testis around the axis of the spermatic cord results in tissue ischaemia and testicular torsion (TT). TT in the newborn infant in the 1st month of life is referred to as neonatal TT (NTT) or perinatal TT and occurs in 6.1/100, 000 live births. The true incidence could be higher as some of these occur prenatally and can be asymptomatic. TT can be extravaginal, intravaginal and mesorchial and NTT is usually extravaginal. Physical examination can be adequate for the diagnosis, and utility of ultrasound (US) is mainly to exclude other conditions. If the timing of the torsion is prenatal, the testicle may not be salvageable. But, in certain situations, these could be asymptomatic bilateral TT. When the timing of torsion is not simultaneous (asynchronous torsion) early contralateral orchiopexy done at the time of exploration would prevent the occurence of asynchronous torsion. Non.operative maneuvres to detorse in NTT are not successful and not recommended. This review focuses on the diagnostic approach and management.
Collapse
Affiliation(s)
- Ranjit I Kylat
- Department of Pediatrics, College of Medicine, University of Arizona, Tucson, AZ, w, Tucson
| | - Mohamed N Ahmed
- Department of Pediatrics, College of Medicine, University of Arizona, Tucson, AZ, w, Tucson
| |
Collapse
|
7
|
Kylat RI. Perinatal testicular torsion. Arch Pediatr 2020; 28:75-79. [PMID: 33277134 DOI: 10.1016/j.arcped.2020.10.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2020] [Revised: 07/27/2020] [Accepted: 10/31/2020] [Indexed: 10/22/2022]
Abstract
Testicular torsion (TT) occurs when the testis rotates around the axis of the spermatic cord attachments and prevents blood flow to the testis, resulting in tissue ischemia. If this occurs in the first month of life it is referred to as "perinatal TT" (PTT) or "neonatal TT" (NTT). PTT has an incidence of 6.1 per 100,000 live births. Some of these cases occur prenatally. It can be missed on the initial newborn examination, as it can be asymptomatic. Hence, the true incidence is much higher since it is underdiagnosed. The types of TT include extravaginal, intravaginal, and mesorchial. Most cases of PTT are extravaginal. The diagnosis can generally be made on physical examination. Ultrasonography (US) can help exclude other rare diagnoses as long as surgical intervention is not delayed. There has been some debate regarding the timing of surgery. Although the torsed testicle may not be salvageable, the likelihood of asymptomatic bilateral TT has to be borne in mind and contralateral orchiopexy done at the time of exploration would prevent an asynchronous torsion. Nonoperative maneuvers to detorse in PTT are not recommended. The evaluation, diagnostic approach, and management of this relatively rare condition are described.
Collapse
Affiliation(s)
- R I Kylat
- Department of Pediatrics, University of Arizona, College of Medicine, PO BOX 245073, 1501 N Campbell Avenue, Tucson, AZ 85724, USA.
| |
Collapse
|
8
|
Hong H, Cai W, Wu J, Wu X, Lin L, Li T, Zhu Q, Gao Y, Ye L, Wei Y, Yang J. Scrotoscopy and traditional open surgery shows a high degree of consistency in the diagnosis of testicular torsion: An initial report. Medicine (Baltimore) 2020; 99:e21545. [PMID: 32756211 PMCID: PMC7402747 DOI: 10.1097/md.0000000000021545] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/04/2022] Open
Abstract
Traditional open surgery (OS) is usually necessary when testicular torsion (TT) cannot be excluded by scrotal ultrasound. Scrotoscopy has been used as a minimally invasive technique to diagnose or treat scrotal diseases, and it may also play a role in diagnosing TT.A retrospective analysis was performed for patients with TT to evaluate the consistency of scrotoscopy and OS in the diagnosis of TT. In the cases where preoperational Color Doppler ultrasonography was performed, scrotoscopy, open surgery, and confirmed TT were included for future analysis.A total of 43 patients were studied. Twisted testes were retained in 11 cases (25.59%), and the remaining 32 patients (74.41%) underwent orchiectomy. There were significant differences in the diagnostic value between the grading of scrotoscopy and ultrasound, as well as between ultrasound grading and blood supply grading (BSG) (both P < .05). However, no significant difference was observed between the grading of scrotoscopy and BSG in traditional OS (P > .05), but a high degree of consistency existed between scrotoscopy grading and BSG in traditional OS (Kappa = 0.733, P ≤ .001).Our limited data indicate that the diagnosis of testicular torsion by scrotoscopy is highly consistent with that of traditional surgical exploration. Therefore, further studies are necessary to confirm its application value in the future. Scrotoscopy may have potential application value for the patients whom testicular torsion are insufficiently diagnosed but cannot be excluded.
Collapse
Affiliation(s)
- Huaishan Hong
- Shengli Clinical Medical College of Fujian Medical University
- Department of Urology, Fujian Provincial Hospital South Branch
| | - Wanghai Cai
- Shengli Clinical Medical College of Fujian Medical University
- Department of Urology, Fujian Provincial Hospital, Fuzhou
| | - Jinfeng Wu
- Shengli Clinical Medical College of Fujian Medical University
- Department of Urology, Fujian Provincial Hospital, Fuzhou
| | - Xiang Wu
- Shengli Clinical Medical College of Fujian Medical University
- Department of Urology, Fujian Provincial Hospital, Fuzhou
| | - Le Lin
- Shengli Clinical Medical College of Fujian Medical University
- Department of Urology, Fujian Provincial Hospital, Fuzhou
| | - Tao Li
- Shengli Clinical Medical College of Fujian Medical University
- Department of Urology, Fujian Provincial Hospital, Fuzhou
| | - Qingguo Zhu
- Shengli Clinical Medical College of Fujian Medical University
- Department of Urology, Fujian Provincial Hospital, Fuzhou
| | - Yunliang Gao
- Department of Urology, the Second Xiangya Hospital, Central South University, Changsha, China
| | - Liefu Ye
- Shengli Clinical Medical College of Fujian Medical University
- Department of Urology, Fujian Provincial Hospital, Fuzhou
| | - Yongbao Wei
- Shengli Clinical Medical College of Fujian Medical University
- Department of Urology, Fujian Provincial Hospital, Fuzhou
| | - Jinrui Yang
- Department of Urology, the Second Xiangya Hospital, Central South University, Changsha, China
| |
Collapse
|
9
|
Osumah TS, Jimbo M, Granberg CF, Gargollo PC. Frontiers in pediatric testicular torsion: An integrated review of prevailing trends and management outcomes. J Pediatr Urol 2018; 14:394-401. [PMID: 30087037 DOI: 10.1016/j.jpurol.2018.07.002] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/25/2018] [Accepted: 07/13/2018] [Indexed: 12/12/2022]
Abstract
Testicular torsion remains the most frequent cause of testicular ischemia, especially in adolescents and young adults. Timely diagnosis and intervention are keys to saving the affected testicle. This review presents current trends in the diagnosis and treatment of torsion, potential pitfalls and consequent outcomes. Additionally, other salient issues surrounding testicular torsion are also discussed, including: pathogenesis of injury, legal ramifications, fertility outcomes, novel management techniques, and recent advances in diagnostic technology.
Collapse
Affiliation(s)
- T S Osumah
- Department of Urology, Mayo Clinic, Rochester, MN, USA
| | - M Jimbo
- Department of Urology, Mayo Clinic, Rochester, MN, USA
| | - C F Granberg
- Department of Urology, Mayo Clinic, Rochester, MN, USA
| | - P C Gargollo
- Department of Urology, Mayo Clinic, Rochester, MN, USA.
| |
Collapse
|
10
|
McDowall J, Adam A, Gerber L, Enyuma COA, Aigbodion SJ, Buchanan S, Laher AE. The ultrasonographic "whirlpool sign" in testicular torsion: valuable tool or waste of valuable time? A systematic review and meta-analysis. Emerg Radiol 2018; 25:281-292. [PMID: 29335899 DOI: 10.1007/s10140-018-1579-x] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2017] [Accepted: 01/03/2018] [Indexed: 12/17/2022]
Abstract
PURPOSE A positive whirlpool sign (WS) is defined as the presence of a spiral-like pattern when the spermatic cord is assessed during ultrasonography (US), using standard, high-resolution ultrasonography (HRUS) and/or color Doppler sonography (CDS), in the presence of testicular torsion. The objective of this review was to assess the validity and accuracy of this sign by performing a comprehensive systematic literature review and meta-analysis. METHODS In accordance with the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines, a comprehensive literature search was performed (August, 2017), using the following databases: BMJ Best Practice, Cochrane Library, Embase, PubMed, Scopus, and Web of Science. Selected studies were further assessed for relevance and quality using the Oxford 2010 Critical Appraisal Skills Program (CASP). RESULTS Of the studies assessed, a total of 723 participants were included, with a mean of 72.3 (SD 71.9) participants. Of the participants, 226 (31.3%) were diagnosed with testicular torsion (TT). Meta-analysis of the studies that provided sufficient data resulted in a pooled sensitivity and specificity of the WS of 0.73 (95% CI, 0.65-0.79) and 0.99 (95% CI, 0.92-0.99), respectively. Removal of all neonates increased the pooled sensitivity to 0.92 (95% CI, 0.70-0.98) while the pooled specificity remained almost unchanged at 0.99 (95% CI, 0.95-1.00). The estimated summary effect of all studies with sufficient data was 4.34 (95% CI, 1.01-7.67; n = 394; p = 0.001). A large degree of heterogeneity was suggested by an I2 statistic of 88.27% (95% CI, 68.60-98.68%). Removal of neonatal subjects increased the estimated summary effect to 5.32 (95% CI, 1.59-9.05; n = 375; p = 0.001). CONCLUSION The WS, when correctly diagnosed, may be viewed as a very definitive sign for TT in the pediatric and adult populations. However, its role in neonates is limited.
Collapse
Affiliation(s)
- Jared McDowall
- Division of Emergency Medicine, Faculty of Health Sciences, University of the Witwatersrand, 07 York Road, Parktown, Johannesburg, 2193, South Africa.
| | - Ahmed Adam
- Division of Urology, Department of Surgery, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Louis Gerber
- Division of Emergency Medicine, Faculty of Health Sciences, University of the Witwatersrand, 07 York Road, Parktown, Johannesburg, 2193, South Africa
| | - Callistus O A Enyuma
- Division of Emergency Medicine, Faculty of Health Sciences, University of the Witwatersrand, 07 York Road, Parktown, Johannesburg, 2193, South Africa.,Department of Paediatrics, Faculty of Medicine, University of Calabar, Calabar, Nigeria
| | - Sunday J Aigbodion
- Division of Emergency Medicine, Faculty of Health Sciences, University of the Witwatersrand, 07 York Road, Parktown, Johannesburg, 2193, South Africa
| | - Sean Buchanan
- Division of Emergency Medicine, Faculty of Health Sciences, University of the Witwatersrand, 07 York Road, Parktown, Johannesburg, 2193, South Africa.,Africa Institute of Emergency Medicine, Johannesburg, South Africa
| | - Abdullah E Laher
- Division of Emergency Medicine, Faculty of Health Sciences, University of the Witwatersrand, 07 York Road, Parktown, Johannesburg, 2193, South Africa
| |
Collapse
|