1
|
Li X, Zhou M, Wang S, Zhang C. The role of multimodal ultrasound in diagnosis of fetal bowel dilatation and prediction of adverse neonatal outcomes: A study of 86 cases in a series of 43,562 births. Heliyon 2024; 10:e27455. [PMID: 38463772 PMCID: PMC10923836 DOI: 10.1016/j.heliyon.2024.e27455] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2023] [Revised: 02/28/2024] [Accepted: 02/28/2024] [Indexed: 03/12/2024] Open
Abstract
Objective To investigate the diagnostic utility of multimodal ultrasound for fetal bowel dilatation (FBD) in different parts of the bowel and to examine its prognostic potential in FBD. Methods This retrospective study analyzed 86 fetuses with a dilated bowel identified via ultrasound in a 10-month postnatal follow-up. Both two- and three dimensional (2D and 3D, respectively) ultrasound volume imaging were used to characterize dilation across different bowel sections. The optimal intestinal diameter cut-off values for pathological bowel dilatation were determined and a predictive model for neonatal surgery was developed. Results The 86 cases of dilatation were distributed as follows: duodenal (n = 36); jejunum/ileum (n = 35); and colonic (n = 15). Duodenal dilatations presented the earliest during pregnancy compared to the other 2 groups (24.4 versus [vs.] 29 vs. 33.7 weeks respectively; p < 0.05). Cases with small intestinal dilatation were delivered earlier than those with colonic dilatation (p < 0.05). Infants with duodenal dilatation had the lowest birth weight and the highest rate of multi-system abnormalities (30.6% vs. 5.7% vs. 20%; p < 0.001). More than one-half of the multi-system abnormalities had chromosomal abnormalities (multiple, 54% vs. single, 12.5%; p = 0.015). There were 2 stillbirths, 24 induced labors, 44 postnatal surgeries, and 18 normal cases after birth. In predicting adverse neonatal outcomes of jejunum/ileum dilatation using a cut-off value of 15.5 mm small intestine diameter, sensitivity was 81.5%, specificity was 62.5%, and the area under the receiver operating characteristic curve (AUC) was 0.762 (p < 0.05). For colonic dilatation, using a cut-off value of 21.5 mm colon diameter: sensitivity was 83.3%, specificity was 77.8%, and AUC was 0.861 (p < 0.05). In detecting jejunum/ileum and colonic obstruction, 3D ultrasound demonstrated significantly better diagnostic efficiency than 2D ultrasound (p < 0.05). Using the backward stepwise selection method, a predictive model for neonatal surgery in patients with jejunum/ileum and colonic dilatation was established: logit (P) = -1.58 + (2.32 × polyhydramnios) +(2.0 × ascites) +(1.14 × hyperechogenic bowel). The AUC for the prediction model was 0.874 (p < 0.05), with 76% sensitivity and 94.1% specificity. Conclusions Duodenal dilatation occurred earlier, with a higher incidence of chromosomal abnormalities and multi-system abnormalities than dilatation of other parts of the bowel. 3D ultrasound played an important role in the detection of jejunum/ileum and colon obstructions. Clinical signs, including polyhydramnios, ascites, and strong echoes in the intestine, can be used to predict neonatal surgery.
Collapse
Affiliation(s)
- Xuelei Li
- Department of Ultrasound, Anhui Province Maternity and Child Health Hospital, Anhui, China
| | - Meng Zhou
- Department of Ultrasound, Anhui Province Maternity and Child Health Hospital, Anhui, China
| | - Shanshan Wang
- Department of Ultrasound, Anhui Province Maternity and Child Health Hospital, Anhui, China
| | - Chaoxue Zhang
- Department of Ultrasound, First Affiliated Hospital of Anhui Medical University, Anhui, China
| |
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
|
Wunsch R. [Ultrasound imaging of the testes in children and adolescents]. RADIOLOGIE (HEIDELBERG, GERMANY) 2024; 64:35-44. [PMID: 37853238 DOI: 10.1007/s00117-023-01220-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 09/13/2023] [Indexed: 10/20/2023]
Abstract
BACKGROUND Ultrasound, the imaging method of choice to evaluate abnormalities of the testes and the scrotum, provides accurate anatomic details and allows the assessment of perfusion using color Doppler and power Doppler. Ultrasound represents a rapid and reliable procedure which in most cases leads to a conclusive diagnosis. DIFFERENTIAL DIAGNOSIS The three most common conditions in the clinical picture of acute scrotum are testicular torsion, torsion of the testicular appendages and inflammatory changes of the testis and the epididymis (epididymo-orchitis). Especially in the case of testicular torsion, rapid diagnosis is essential since time is an important factor to initiate organ-preserving therapy. EQUIPMENT TECHNOLOGY High-frequency linear array transducer (at least 10 MHz), which allows detection of slow flow rates, is recommended.
Collapse
Affiliation(s)
- R Wunsch
- Klinik für Radiologie, Kinderradiologie und Nuklearmedizin, St. Elisabeth Gruppe GmbH, Katholische Kliniken Rhein-Ruhr, Marienhospital Witten, Marienplatz 2, 58452, Witten, Deutschland.
| |
Collapse
|
4
|
Lacy A, Smith A, Koyfman A, Long B. High risk and low prevalence diseases: Testicular torsion. Am J Emerg Med 2023; 66:98-104. [PMID: 36738571 DOI: 10.1016/j.ajem.2023.01.031] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2022] [Revised: 01/17/2023] [Accepted: 01/20/2023] [Indexed: 01/27/2023] Open
Abstract
INTRODUCTION Testicular torsion is a serious condition that carries with it a high rate of morbidity. OBJECTIVE This review highlights the pearls and pitfalls of testicular torsion, including presentation, diagnosis, and management in the emergency department (ED) based on current evidence. DISCUSSION Testicular torsion is a urological emergency that occurs with rotation of the testicle along its supporting ligaments leading to obstruction of vascular flow. A key risk factor is the presence of a bell-clapper deformity. The most common population affected includes children in a bimodal distribution with the most cases occurring in the first year of life and between 12 and 18 years, although cases do occur in adults. Acute, severe, unilateral scrotal pain is the most common presenting symptom. Nausea and vomiting are common, but the presence or absence of a cremasteric reflex is not a reliable indicator of disease. The TWIST score may assist with clinical decision making in patients presenting with acute testicular pain but should not be used in isolation. If torsion is suspected or confirmed, consultation with the urology specialist should not be delayed, as outcomes are time sensitive. Ultrasound can be used for diagnosis, but a normal ultrasound examination cannot exclude the diagnosis. Treatment includes emergent urology consultation for surgical exploration and detorsion, as well as symptomatic therapy in the ED. Manual detorsion can be attempted in the ED while awaiting transfer or consultation. CONCLUSIONS An understanding of testicular torsion can assist emergency clinicians in diagnosing and managing this disease.
Collapse
Affiliation(s)
- Aaron Lacy
- Department of Emergency Medicine, Washington University School of Medicine, St Louis, MS, USA.
| | - Amanda Smith
- Department of Emergency Medicine, Vanderbilt University Medical Center, 1211 Medical Center Dr, Nashville, TN, USA.
| | - Alex Koyfman
- Department of Emergency Medicine, UT Southwestern, Dallas, TX, USA
| | - Brit Long
- Department of Emergency Medicine, Brooke Army Medical Center, Fort Sam, Houston, TX, USA.
| |
Collapse
|
5
|
Hosokawa T, Urushibara A, Tanami Y, Sato Y, Ishimaru T, Ohashi K, Kawashima H, Oguma E. Prediction of testicular atrophy based on sonographic findings immediately after successful manual detorsion. Australas J Ultrasound Med 2023; 26:26-33. [PMID: 36960131 PMCID: PMC10030091 DOI: 10.1002/ajum.12325] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Purpose To investigate and determine the sonographic findings obtained from manually distorted testes to predict testicular atrophy following manual detorsion. Materials and methods Twenty-two patients who had been diagnosed with testicular torsion and undergone manual detorsion were included. These patients were classified according to the presence or absence of testicular atrophy. The duration of symptoms, presence or absence of hyperperfusion within the entire affected testis, and echogenicity (homogeneous or heterogeneous) within the affected testis were compared using the Mann-Whitney U-test or Fisher's exact test, as appropriate. Results Testicular atrophy was detected in seven patients. There was a significant difference in the frequency of hyperperfusion within the entire affected testis (with atrophy [present/absent] vs. without atrophy [present/absent] = 0/7 vs. 8/7, P = 0.023) between patients with and without testicular atrophy. No significant differences in the duration of symptoms (with atrophy vs. without atrophy = 7 ± 3.3 h vs. 4.7 ± 3.6 h, P = 0.075) or frequency of echogenicity within the testis (with atrophy [heterogeneous/homogeneous] vs. without atrophy [heterogeneous/homogeneous] = 2/5 vs. 2/13, P = 0.565) were observed between the groups. Conclusions This small cohort study suggests that the presence of hyperperfusion within the entire affected testis immediately after successful manual detorsion is useful in predicting the avoidance of testicular atrophy.
Collapse
Affiliation(s)
- Takahiro Hosokawa
- Department of RadiologySaitama Children's Medical Center1‐2 Shintoshin Chuo‐ku SaitamaSaitamaJapan
| | - Aiko Urushibara
- Department of RadiologySaitama Children's Medical Center1‐2 Shintoshin Chuo‐ku SaitamaSaitamaJapan
| | - Yutaka Tanami
- Department of RadiologySaitama Children's Medical Center1‐2 Shintoshin Chuo‐ku SaitamaSaitamaJapan
| | - Yumiko Sato
- Department of RadiologySaitama Children's Medical Center1‐2 Shintoshin Chuo‐ku SaitamaSaitamaJapan
| | - Tetsuya Ishimaru
- Department of SurgerySaitama Children's Medical Center1‐2 Shintoshin Chuo‐ku SaitamaSaitamaJapan
| | - Kensuke Ohashi
- Department of UrologySaitama Children's Medical Center1‐2 Shintoshin Chuo‐ku SaitamaSaitamaJapan
| | - Hiroshi Kawashima
- Department of SurgerySaitama Children's Medical Center1‐2 Shintoshin Chuo‐ku SaitamaSaitamaJapan
| | - Eiji Oguma
- Department of RadiologySaitama Children's Medical Center1‐2 Shintoshin Chuo‐ku SaitamaSaitamaJapan
| |
Collapse
|
6
|
Mori T, Ihara T, Nomura O. Diagnostic accuracy of point-of-care ultrasound for paediatric testicular torsion: a systematic review and meta-analysis. J Accid Emerg Med 2023; 40:140-146. [PMID: 35523539 DOI: 10.1136/emermed-2021-212281] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2021] [Accepted: 04/24/2022] [Indexed: 01/27/2023]
Abstract
BACKGROUND Previous studies have examined the utility of ultrasonography performed by radiologists for diagnosing paediatric testicular torsion. While point-of-care ultrasound (POCUS) is used in paediatric emergency medicine, its diagnostic accuracy is still unknown. OBJECTIVES The present systematic review and meta-analysis aimed to clarify the accuracy of POCUS in diagnosing testicular torsion in children. METHODS Following the Preferred Reporting Items for Systematic Review and Meta-analysis of Diagnostic Test Accuracy guidelines, a systematic review was performed using the indices of MEDLINE, EMBASE plus EMBASE classics, PubMed and the Cochrane database from inception to November 2020. Any study investigating the diagnostic accuracy of POCUS for paediatric testicular torsion was extracted. The primary outcome was the assessment of the diagnostic accuracy of POCUS for paediatric testicular torsion. The pooled sensitivity and specificity were calculated. Quality analysis was conducted using Quality Assessment of Diagnostic Accuracy Studies-2 (QUADAS-2). RESULTS Four studies enrolling 784 patients in total were included. The pooled sensitivity, specificity, and positive and negative likelihood ratios of POCUS were 98.4% (95% CI: 88.5% to 99.8%), 97.2% (95% CI: 87.2% to 99.4%), 34.7 (95% CI: 7.4 to 164.4) and 0.017 (95% CI: 0.002 to 0.12), respectively. Risk-of-bias assessment using QUADAS-2 revealed that two of the studies had a high risk of bias in patient selection. CONCLUSION The present systematic review and meta-analysis showed that POCUS had high sensitivity and specificity for identifying testicular torsion in paediatric patients although the risk of bias was high in the studies analysed.
Collapse
Affiliation(s)
- Takaaki Mori
- Division of Pediatric Emergency Medicine, Tokyo Metropolitan Children's Medical Center, Tokyo, Japan .,Department of Emergency Medicine, KK Women's and Children's Hospital, Singapore
| | - Takateru Ihara
- Division of Pediatric Emergency Medicine, Tokyo Metropolitan Children's Medical Center, Tokyo, Japan
| | - Osamu Nomura
- Department of Emergency and Disaster Medicine, Hirosaki University, Hirosaki, Japan
| |
Collapse
|
7
|
Zvizdic Z, Aganovic A, Milisic E, Jonuzi A, Zvizdic D, Vranic S. The Role of Demographic and Clinical Characteristics in Distinguishing Testicular Torsion from Torsion of the Appendix Testis: A Single-center Retrospective Study. Prague Med Rep 2023; 124:255-264. [PMID: 37736949 DOI: 10.14712/23362936.2023.20] [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] [Indexed: 09/23/2023] Open
Abstract
The acute scrotum (AS) in the pediatric population is a medical emergency. AS is usually caused by testicular torsion (TT) and torsion of the appendix testis (TAT). The current study explored which demographic and clinical characteristics can help distinguish between TT and TAT. We analyzed all children ≤16 years who underwent surgical exploration for AS. The patients were divided into Group 1/TT and Group 2/TAT. Ninety patients were included in the study (24 with TT and 66 with TAT). The peak incidence of TT was significantly higher than in the TAT group (p<0.001). Scrotal pain was more prevalent in the TAT group (p=0.02), whereas systemic signs (nausea/vomiting and abdominal pain) affected more frequently the TT patients (p=0.003 and p<0.001, respectively). The duration of symptoms was significantly longer in the TAT group (p<0.001). The duration of symptoms in the TT cohort significantly impacted the testicular salvage (p=0.008). Color Doppler ultrasound (CDUS) findings of absent/decreased testicular blood flow in the affected testis strongly favored the diagnosis of TT (p<0.001). The older age, shorter duration of symptoms, systemic signs, and CDUS findings can help distinguish between the two most common acute scrotum causes.
Collapse
Affiliation(s)
- Zlatan Zvizdic
- Clinic of Pediatric Surgery, University Clinical Center Sarajevo, Sarajevo, Bosnia and Herzegovina
| | | | - Emir Milisic
- Clinic of Pediatric Surgery, University Clinical Center Sarajevo, Sarajevo, Bosnia and Herzegovina
| | - Asmir Jonuzi
- Clinic of Pediatric Surgery, University Clinical Center Sarajevo, Sarajevo, Bosnia and Herzegovina
| | - Denisa Zvizdic
- Eye Clinic, University Clinical Center Sarajevo, Sarajevo, Bosnia and Herzegovina
| | - Semir Vranic
- College of Medicine, QU Health, Qatar University, Doha, Qatar.
| |
Collapse
|
8
|
Shiohara T, Miyazaki O, Hasegawa Y, Uematsu S, Nosaka S. Solitary whirlpool sign demonstrated with testicular torsion on ultrasonography. Pediatr Int 2023; 65:e15566. [PMID: 37368508 DOI: 10.1111/ped.15566] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2022] [Revised: 05/12/2023] [Accepted: 05/17/2023] [Indexed: 06/29/2023]
Affiliation(s)
- Takumi Shiohara
- Department of Radiology, National Center for Child Health and Development, Tokyo, Japan
| | - Osamu Miyazaki
- Department of Radiology, National Center for Child Health and Development, Tokyo, Japan
| | - Yuichi Hasegawa
- Division of Urology, National Center for Child Health and Development, Tokyo, Japan
| | - Satoko Uematsu
- Division of Emergency and Transport Services, National Center for Child Health and Development, Tokyo, Japan
| | - Shunsuke Nosaka
- Department of Radiology, National Center for Child Health and Development, Tokyo, Japan
| |
Collapse
|
9
|
Aydin S, Tokur O, Kazci O, Ece B, Karavas E, Kantarci M. Sonographic findings of COVID-19 related acute scrotal infection and associations with clinical-laboratory data. JOURNAL OF CLINICAL ULTRASOUND : JCU 2022; 50:1385-1390. [PMID: 35775362 PMCID: PMC9349983 DOI: 10.1002/jcu.23263] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 04/02/2022] [Revised: 05/15/2022] [Accepted: 06/16/2022] [Indexed: 06/15/2023]
Abstract
BACKGROUND During the Coronavirus Disease 2019 (COVID-19) pandemic, patients present to hospitals with a wide range of symptoms. Some of these symptoms include acute orchitis and epididymitis. The goal of this research is to see if COVID-19 infection and scrotal infection are associated. MATERIALS AND METHODS Patients with a COVID-19 (+) who agreed to a scrotal ultrasound (US) examination were studied prospectively in a tertiary care center between October 2021 and February 2022. The severity of the disease was used to divide patients into groups. Patients diagnosed with acute scrotal infection based on scrotal ultrasonography findings were compared in these groups, as were their age, comorbidities, and laboratory data. RESULTS The median age of the 213 participants was 61.7 ± 8.3. During the ultrasonographic examination of the patients, 15 (7%), 8 (3.7%), 17 (7.9%), and 40 (18.7%) were diagnosed with acute orchitis, acute epididymitis, acute epididymo-orchitis, and scrotal infection, respectively. Acute scrotal infection was far more common in patients with a higher clinical severity of the disease. The patients' comorbidities were also assessed, and it was discovered that they were statistically more common in the same group. CONCLUSIONS Even if there are no clinical symptoms, ultrasonography can help detect acute scrotal infection in COVID-19 patients. Furthermore, in groups with higher clinical severity, this association is more likely to be seen. It is critical to understand this in order to avoid complications.
Collapse
Affiliation(s)
- Sonay Aydin
- Department of RadiologyErzincan UniversityErzincanTurkey
| | - Oğuzhan Tokur
- Department of RadiologyAnkara Training and Research HospitalAnkaraTurkey
| | - Omer Kazci
- Department of RadiologyYuksek Ihtisas UniversityAnkaraTurkey
| | - Bunyamin Ece
- Department of RadiologyKastamonu UniversityKastamonuTurkey
| | - Erdal Karavas
- Department of RadiologyErzincan UniversityErzincanTurkey
| | - Mecit Kantarci
- Department of RadiologyErzincan UniversityErzincanTurkey
| |
Collapse
|
10
|
Smith W, Midgley S, Kummer T. Real-time Ultrasound-Guided Manual Testicular Detorsion: A Case Report. Clin Pract Cases Emerg Med 2022; 6:248-251. [PMID: 36049193 PMCID: PMC9436502 DOI: 10.5811/cpcem2022.6.57256] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2022] [Accepted: 06/29/2022] [Indexed: 11/11/2022] Open
Abstract
Introduction: Acute testicular torsion is a surgical emergency due to acute testicular ischemia. Manual testicular detorsion is a testis-saving, bedside therapeutic when performed correctly and in a timely fashion. This procedure is most commonly performed blindly with pain relief as the endpoint for detorsion. However, up to one-third of patients continued to show signs of residual torsion in the operating room even using pain relief as the stopping point for the procedure. Case Report: We present a case demonstrating the utility of color Doppler ultrasound to confirm complete manual detorsion in a 14-year-old male with acute testicular torsion. The patient underwent 360-degree detorsion and had relief of pain; however, color Doppler demonstrated incomplete return of flow to the testis. After an additional 180-degree turn was made, color Doppler demonstrated complete return of normal vascular flow to the torsed testis. Conclusion: When it comes to testicular viability, timely restoration of blood flow to the testicle is of utmost importance. Manual detorsion is a non-invasive intervention that can be quickly and effectively performed at the bedside. Moreover, using color Doppler ultrasound guidance can ensure that physicians detorse in the proper direction and to completion, by providing instant visualization of restorative flow and ensuring reperfusion of the testis while awaiting definitive surgical management.
Collapse
Affiliation(s)
- Wilson Smith
- Vassar Brothers Medical Center, Department of Emergency Medicine, Poughkeepsie, New York
| | - Stephanie Midgley
- Vassar Brothers Medical Center, Department of Emergency Medicine, Poughkeepsie, New York
| | - Tobias Kummer
- Mayo Clinic, Department of Emergency Medicine, Rochester, Minnesota
| |
Collapse
|
11
|
Beşler MS, Gökhan MB, Ölçücüoğlu E, Özdemir FAE. Shear wave elastography for the evaluation of testicular salvage after testicular torsion. Andrologia 2022; 54:e14565. [PMID: 35973680 DOI: 10.1111/and.14565] [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: 04/12/2022] [Revised: 06/29/2022] [Accepted: 08/07/2022] [Indexed: 11/30/2022] Open
Abstract
The aim of this study was to assess the utility of shear wave elastography in the follow-up of testicular detorsion, evaluate long-term outcomes, and explore its relationship with parameters such as tissue stiffness values, pain duration, and torsion type. Elastography examinations were independently performed by two radiologists to evaluate patients who presented to our hospital for follow-up after being diagnosed with testicular torsion and age-matched controls. Inter-observer variability of the mean testicular tissue elasticity was excellent (Intraclass correlation coefficient: 0.939, p < 0.001). Median time between testicular detorsion and follow-up ultrasound examination was 18 months (range, 11-36 months). Torsion side, torsion degree, and pain duration were recorded, and testicular volumes were calculated. The study population comprised 24 patients (48 testes) with a mean age of 21.1 ± 7.8 years. The mean testicular volume was measured as 12.3 ± 5.4 ml for the testicular salvage group, 13.9 ± 3.8 ml for the contralateral testes, and 13.7 ± 2.7 ml for the control group (p = 0.553). The mean testicular speed mode values were higher in the testicular salvage group (1.34 ± 1.21 m/s) compared with the contralateral testes group (1.00 ± 0.08 m/s), and the control group (1.01 ± 0.06 m/s), however there was no statistically significant difference between the three groups (p = 0.861). While testicular atrophy was detected in three patients, an intraparenchymal wedge-shaped focal hypoechoic area developed after torsion in a further three patients. The elastography examination for focal hypoechoic areas revealed an increase or decrease in tissue stiffness compared to the normal parenchyma. The tissue stiffness values of the testicular salvage group were higher in complete torsion compared to incomplete torsion. The elastography method contributes to other imaging methods in distinguishing focal lesion areas that can be seen after testicular torsion from malignant conditions. Elastography presents as a feasible and practical complementary modality for the follow-up of testicular salvage after torsion.
Collapse
Affiliation(s)
| | | | - Esin Ölçücüoğlu
- Department of Radiology, Ankara City Hospital, Ankara, Turkey
| | | |
Collapse
|
12
|
Comparison of demographic and clinical characteristics in distinguishing testicular torsion from torsion of the appendix testis: A single-center retrospective study. Asian J Urol 2022. [DOI: 10.1016/j.ajur.2022.04.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
|
13
|
Sintim-Damoa A, Cohen HL. Pearls and Pitfalls of Pediatric Scrotal Imaging. Semin Ultrasound CT MR 2022; 43:115-129. [PMID: 35164905 DOI: 10.1053/j.sult.2021.05.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Ultrasonography (US) is the primary imaging modality for the evaluation of pediatric scrotal disease. The ability to obtain exceptional anatomical detail and testicular perfusion information without ionizing radiation makes it the essential tool for evaluating scrotal pain and palpable masses. Challenges arise in both the performance and interpretation of scrotal US in the child. Optimizing imaging parameters and recognizing key differentiating US features help minimize misinterpretations that can lead to poor patient outcomes. Key pearls and pitfalls in pediatric scrotal ultrasound methods and diagnoses are reviewed. Knowledge of what is normal for the various ages of childhood from neonate through adolescence is necessary for accurate US analysis. Imaging evaluation of key causes of the acute painful scrotum including testicular appendage torsion, epididymitis, and testicular torsion are discussed. Sonographic features for the diagnosis of benign and malignant scrotal masses, microlithiasis, and cryptorchidism are reviewed.
Collapse
Affiliation(s)
- Akosua Sintim-Damoa
- Department of Radiology, LeBonheur Children's Hospital, University of Tennessee Health Science Center, Memphis, TN
| | - Harris L Cohen
- Department of Radiology, LeBonheur Children's Hospital, University of Tennessee Health Science Center, Memphis, TN.
| |
Collapse
|
14
|
Gupta A, Croake A, Rubens D, Dogra V. Do Not Get It Twisted: Common and Uncommon Manifestations of Testicular Torsion. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2022; 41:271-283. [PMID: 33885184 DOI: 10.1002/jum.15723] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/31/2021] [Accepted: 04/02/2021] [Indexed: 06/12/2023]
Abstract
Color flow and spectral Doppler ultrasound are the backbone of scrotal imaging when evaluating acute scrotal pain. Testicular Torsion is one of the most common causes of acute scrotal pain but can be a challenging diagnosis both clinically and sonographically. This article will review the pertinent Doppler ultrasound findings that can help make the diagnosis of both complete and partial torsion. A review of other causes of testicular ischemia will also be included as these pathologies can mimic Testicular Torsion.
Collapse
Affiliation(s)
- Akshya Gupta
- Department of Imaging Sciences, University of Rochester, Rochester, New York, USA
| | - Alexander Croake
- Department of Imaging Sciences, University of Rochester, Rochester, New York, USA
| | - Deborah Rubens
- Department of Imaging Sciences, University of Rochester, Rochester, New York, USA
| | - Vikram Dogra
- Department of Imaging Sciences, University of Rochester, Rochester, New York, USA
| |
Collapse
|
15
|
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
|
16
|
Hosokawa T, Tanami Y, Sato Y, Ishimaru T, Kawashima H, Oguma E. Role of ultrasound in manual detorsion for testicular torsion. JOURNAL OF CLINICAL ULTRASOUND : JCU 2021; 49:860-869. [PMID: 34240428 DOI: 10.1002/jcu.23039] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/22/2021] [Revised: 05/03/2021] [Accepted: 06/27/2021] [Indexed: 06/13/2023]
Abstract
PURPOSE Manual detorsion can be performed for testicular torsion before scrotal exploration. Using sonographic findings, this study investigated the need for additional treatments after manual detorsion for testicular torsion. METHODS This study evaluated 13 retrospective cases of testicular torsion subjected to manual detorsion. Manual detorsion was classified as failure or success based on residual spermatic cord twist. The following sonographic findings of the affected testis were compared using the Fisher exact test: whirlpool sign, horizontal or altered lie, and hypoperfusion. RESULTS Manual detorsion failed in five patients. There was a significant difference in the incidence of the whirlpool sign between the two groups (present/absent sign in the failure vs. success groups: 4/1 vs. 0/8, p = 0.007). Horizontal or altered lie and hypoperfusion in the affected testis were not significantly different between groups (5/0 vs. 3/4, p = 0.07, one case excluded, and 5/0 vs. 4/4, p = 0.10, respectively). CONCLUSIONS Ultrasound findings after manual detorsion, particularly, the whirlpool sign, were useful for planning subsequent treatment such as additional manual detorsion or surgical intervention. The testicular axis and the perfusion of the twisted testis may not recover to normal after successful manual detorsion, but if they recover, this procedure could be judged a success.
Collapse
Affiliation(s)
- Takahiro Hosokawa
- Department of Radiology, Saitama Children's Medical Center, Saitama, Japan
| | - Yutaka Tanami
- Department of Radiology, Saitama Children's Medical Center, Saitama, Japan
| | - Yumiko Sato
- Department of Radiology, Saitama Children's Medical Center, Saitama, Japan
| | - Tetsuya Ishimaru
- Department of Surgery, Saitama Children's Medical Center, Saitama, Japan
| | - Hiroshi Kawashima
- Department of Surgery, Saitama Children's Medical Center, Saitama, Japan
| | - Eiji Oguma
- Department of Radiology, Saitama Children's Medical Center, Saitama, Japan
| |
Collapse
|
17
|
Visalli C, Vinci SL, Mondello S, Kobeissy F, Salamone I, Coglitore A, Trimarchi R, Tessitore A, Impellizzeri P, Mormina E. Microvascular imaging ultrasound (MicroV) and power Doppler vascularization analysis in a pediatric population with early scrotal pain onset. Jpn J Radiol 2021; 40:192-201. [PMID: 34515926 DOI: 10.1007/s11604-021-01194-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2021] [Accepted: 09/01/2021] [Indexed: 11/30/2022]
Abstract
INTRODUCTION The power Doppler is a useful tool in the evaluation of pediatric acute scrotal pain. Nonetheless, it may have some inherent limitations in scrotal vascularization analysis, potentially causing unnecessary surgery. The microvascular imaging ultrasound (MicroV) is an innovative Doppler technique able to improve the detection of very low flow. This retrospective study aims to compare both power Doppler and MicroV in the evaluation of a pediatric population with early-stage scrotal pain onset, first in testis vascularization analysis, and second in their diagnostic performances. MATERIALS AND METHODS 69 patients met the following inclusion criteria, age < 18-year-old, a clinical diagnosis of acute scrotal disease, pain onset ≤ 6 h, ultrasound examination (including B-mode, power Doppler, and MicroV), 3-months follow-up. For both power Doppler and MicroV, through a defined vascularization scale, it was evaluated the agreement in vascularization detection, and the sensitivity and specificity in US diagnostic abilities. RESULTS Retrospective diagnoses were of 8 testicular torsion, 15 orchi-epididymitis, and 46 children with other scrotal conditions. Power Doppler provided inconclusive US evaluation in 37.68% of the cases, while MicroV only in the 1.45% (p < 0.0001). Testicular torsion and orchi-epididymitis were identified, respectively, with MicroV in 100% (sensitivity, specificity, PPV, NPV, and accuracy of 100%) and 80% of patients (80% sensitivity, 100% specificity and PPV, 94.73% NPV, 95.65% accuracy); with power Doppler the identification was, respectively, of 87.5% (87.5% sensitivity, 100% specificity and PPV, 98.38% NPV and accuracy) and of 73.3% (73.33% sensitivity, 98.14% specificity, 91.66% PPV, 92.98% NPV, 92.75% accuracy). CONCLUSIONS Our findings indicate that MicroV is a reliable technique in vascularization detection of pediatric testes, being able also to detect vascularization in healthy testicles with no-flow at power Doppler examination. Moreover, MicroV could be a valuable ally in the US diagnostic of children with early-stage scrotal pain onset.
Collapse
Affiliation(s)
- Carmela Visalli
- Department of Biomedical and Dental Sciences and of Morphofunctional Imaging, University of Messina, AOU Policlinico Universitario "G. Martino", Via Consolare Valeria 1, 98122, Messina, Italy
| | - Sergio Lucio Vinci
- Department of Biomedical and Dental Sciences and of Morphofunctional Imaging, University of Messina, AOU Policlinico Universitario "G. Martino", Via Consolare Valeria 1, 98122, Messina, Italy
| | - Stefania Mondello
- Department of Biomedical and Dental Sciences and of Morphofunctional Imaging, University of Messina, AOU Policlinico Universitario "G. Martino", Via Consolare Valeria 1, 98122, Messina, Italy
| | - Firas Kobeissy
- Department of Psychiatry and Neuroscience, McKnight Brain Institute, University of Florida, Gainesville, FL, USA.,Department of Biochemistry and Molecular Genetics, American University of Beirut, Beirut, Lebanon
| | - Ignazio Salamone
- Department of Biomedical and Dental Sciences and of Morphofunctional Imaging, University of Messina, AOU Policlinico Universitario "G. Martino", Via Consolare Valeria 1, 98122, Messina, Italy
| | - Alessandra Coglitore
- Department of Biomedical and Dental Sciences and of Morphofunctional Imaging, University of Messina, AOU Policlinico Universitario "G. Martino", Via Consolare Valeria 1, 98122, Messina, Italy.
| | - Renato Trimarchi
- Department of Biomedical and Dental Sciences and of Morphofunctional Imaging, University of Messina, AOU Policlinico Universitario "G. Martino", Via Consolare Valeria 1, 98122, Messina, Italy
| | - Agostino Tessitore
- Department of Biomedical and Dental Sciences and of Morphofunctional Imaging, University of Messina, AOU Policlinico Universitario "G. Martino", Via Consolare Valeria 1, 98122, Messina, Italy
| | - Pietro Impellizzeri
- Department of Human Pathology in Adults and Developmental Age, Division of Pediatric Surgery, University of Messina, Messina, Italy
| | - Enricomaria Mormina
- Department of Biomedical and Dental Sciences and of Morphofunctional Imaging, University of Messina, AOU Policlinico Universitario "G. Martino", Via Consolare Valeria 1, 98122, Messina, Italy
| |
Collapse
|
18
|
Chen L, Huang X, Yi Z, Deng Q, Jiang N, Feng C, Zhou Q, Sun B, Chen W, Guo R. Ultrasound Imaging Findings of Acute Testicular Infection in Patients With Coronavirus Disease 2019: A Single-Center-Based Study in Wuhan, China. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2021; 40:1787-1794. [PMID: 33174632 DOI: 10.1002/jum.15558] [Citation(s) in RCA: 33] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/21/2020] [Revised: 09/17/2020] [Accepted: 10/05/2020] [Indexed: 05/14/2023]
Abstract
OBJECTIVES Coronavirus disease 2019 (COVID-19), caused by the novel severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), has become a global pandemic, raising widespread public health concerns. Our team treated hospitalized patients with COVID-19 in Wuhan, where the outbreak first began, and we suspected that SARS-CoV-2 may cause testicular infection in male patients. We conducted this study to explore that observation. METHODS We enrolled male patients with a confirmed diagnosis of COVID-19 and performed a bedside ultrasound (US) examination of the scrotum, focused on findings of acute inflammation such as tunica albuginea thickening, enlargement and heterogeneous echogenicity of the testis, epididymis, or both, an abscess, scrotal wall edema, and hydrocele. Then we compared the proportions of observed epididymo-orchitis in patients from different age groups and COVID-19 severity groups. RESULTS A total of 142 patients with COVID-19 were enrolled in our study, and 32 (22.5%) patients had acute orchitis, epididymitis, or epididymo-orchitis on scrotal US imaging, according to the diagnosis criteria. The observed risk of acute scrotal infection increased with age, with the incidence reaching 53.3% in men older than 80 years. We also observed that men with severe COVID-19 had a significantly higher possibility of epididymo-orchitis compared to the nonsevere COVID-19 group (P = .037). CONCLUSIONS This study shows US imaging evidence that SARS-CoV-2 may cause infection of the testis or epididymis, and the risk is worthy of the attention of clinicians.
Collapse
Affiliation(s)
- Liao Chen
- Department of Ultrasound Imaging, Wuhan University Renmin Hospital, Wuhan, China
| | - Xin Huang
- Department of Ultrasound Imaging, Wuhan University Renmin Hospital, Wuhan, China
| | - Zuohuizi Yi
- Department of Ophthalmology, Wuhan University Renmin Hospital, Wuhan, China
| | - Qing Deng
- Department of Ultrasound Imaging, Wuhan University Renmin Hospital, Wuhan, China
| | - Nan Jiang
- Department of Ultrasound Imaging, Wuhan University Renmin Hospital, Wuhan, China
| | - Chuangli Feng
- Department of Ultrasound Imaging, Wuhan University Renmin Hospital, Wuhan, China
| | - Qing Zhou
- Department of Ultrasound Imaging, Wuhan University Renmin Hospital, Wuhan, China
| | - Bin Sun
- Department of Ultrasound Imaging, Wuhan University Renmin Hospital, Wuhan, China
| | - Wenwei Chen
- Department of Ultrasound Imaging, Wuhan University Renmin Hospital, Wuhan, China
| | - Ruiqiang Guo
- Department of Ultrasound Imaging, Wuhan University Renmin Hospital, Wuhan, China
| |
Collapse
|
19
|
Gupta A, Dogra V. Role of color flow Doppler ultrasound in the evaluation of acute scrotal pain. Andrology 2021; 9:1290-1297. [PMID: 34051064 DOI: 10.1111/andr.13058] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2021] [Revised: 05/19/2021] [Accepted: 05/20/2021] [Indexed: 11/26/2022]
Abstract
Color flow Doppler ultrasound is a critical tool in the assessment of the scrotum. Ultrasound is the first-line imaging modality and can rapidly differentiate between surgical and nonsurgical conditions, allowing for appropriate and prompt patient management. We review the role of color flow Doppler in the evaluation of acute scrotal pain, highlighting some of the most commonly seen pathologies such as epididymo-orchitis and testicular torsion.
Collapse
Affiliation(s)
- Akshya Gupta
- Department of Imaging Sciences, University of Rochester, Rochester, New York, USA
| | - Vikram Dogra
- Department of Imaging Sciences, University of Rochester, Rochester, New York, USA
| |
Collapse
|
20
|
Nishizawa T, Kobayashi D, Uematsu H, Taguchi T. Ultrasonographic 'whirlpool sign' in testicular torsion. BMJ Case Rep 2021; 14:14/5/e241638. [PMID: 33972300 PMCID: PMC8112403 DOI: 10.1136/bcr-2021-241638] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Affiliation(s)
- Toshinori Nishizawa
- Department of General Internal Medicine, St Luke's International University, Chuo-ku, Tokyo, Japan .,Department of Family Medicine, Tokyo Medical and Dental University Graduate School of Medical and Dental Sciences, Bunkyo-ku, Tokyo, Japan
| | - Daichi Kobayashi
- Department of General Internal Medicine, Toyota Regional Medical Center, Toyota, Aichi, Japan.,Department of Urology, Toyota Kosei Hospital, Toyota, Aichi, Japan
| | - Haruhiro Uematsu
- Department of General Internal Medicine, Toyota Regional Medical Center, Toyota, Aichi, Japan
| | - Tomohiro Taguchi
- Department of General Internal Medicine, Toyota Regional Medical Center, Toyota, Aichi, Japan.,Department of Community Medicine, Fujita Health University, Toyoake, Japan
| |
Collapse
|
21
|
AIUM Practice Parameter for the Performance of Scrotal Ultrasound Examinations. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2021; 40:E30-E33. [PMID: 33660888 DOI: 10.1002/jum.15667] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/09/2021] [Accepted: 02/10/2021] [Indexed: 06/12/2023]
|
22
|
Deeg KH. Differential Diagnosis of Acute Scrotum in Childhood and Adolescence with High-Resolution Duplex Sonography. ULTRASCHALL IN DER MEDIZIN (STUTTGART, GERMANY : 1980) 2021; 42:10-38. [PMID: 33530122 DOI: 10.1055/a-1325-1834] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
Acute testicular pain in childhood can be caused by testicular torsion, torsion of the appendix testis, or epididymo-orchitis. Quick and reliable diagnosis is essential for determining the further course of action (surgery or conservative approach). The diagnostic tool of choice is high-resolution sonography with a linear transducer (> 10 MHz) combined with color and spectral Doppler sonography. The Doppler device settings should include a low pulse repetition frequency (< 4 cm/s), a low wall filter (< 100 Hz), and adequate gain. Comparison with the unaffected healthy testis is essential. The most important of the three diseases is torsion of the spermatic cord because it requires immediate surgical intervention and detorsion. The affected testis is enlarged and has an inhomogeneous echotexture with hypoechoic and hyperechoic areas as well as an associated hydrocele. In testicular torsion, color Doppler shows reduced or absent intratesticular vessels in comparison with the healthy contralateral testis. Spectral Doppler shows decreased flow velocities especially during diastole in intratesticular arteries and an increased resistance index. The investigation should always include imaging of the spermatic cord from the outer inguinal ring to the upper pole of the testis. In contrast to a normal finding, the vessels and the ductus deferens are not displayed as linear tubular structures but in form of a spiral twist. Ultrasound shows a target-like structure with multiple concentric rings. Color Doppler sonography shows the typical whirlpool sign. In torsion of the appendix testis, the appendix testis is enlarged in the groove between the testis and epididymis. The longitudinal diameter of the appendix testis can be greater than 5 mm. The echogenicity of the torsed appendage can vary between hypoechoic (acute torsion) and hyperechoic (prior torsion). An associated hydrocele of varying size is usually seen. Color Doppler sonography reveals a lack of perfusion of the enlarged appendix testis and increased vascularity of the testis and primarily the epididymis. Epididymo-orchitis is characterized by an enlarged epididymis and/or testis with inhomogeneous echogenicity (hypoechoic - hyperechoic). Color Doppler sonography shows increased vascularity in comparison with the unaffected testis. Spectral Doppler reveals increased diastolic flow velocities and a decreased resistance index. Idiopathic scrotal edema and an incarcerated inguinal hernia must be ruled out in the differential diagnosis.
Collapse
Affiliation(s)
- Karl-Heinz Deeg
- Pediatric Clinic, University of Erlangen-Nuremberg, Erlangen, Germany
| |
Collapse
|
23
|
McLaren PSM. A systematic review on the utility of ultrasonography in the diagnosis of testicular torsion in acute scrotum patients. Radiography (Lond) 2021; 27:943-949. [PMID: 33451883 DOI: 10.1016/j.radi.2020.12.012] [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: 09/26/2020] [Revised: 12/18/2020] [Accepted: 12/26/2020] [Indexed: 10/22/2022]
Abstract
INTRODUCTION Ultrasound is a valuable tool in establishing the cause of acute scrotum pain. However, its role in testicular torsion (TT) detection remains controversial. This review aims integrate pre-existing data to assess the value of B-mode and colour Doppler ultrasound (CDS) features combined in the detection of TT in acute scrotum pain patients of all ages. METHODS A search through electronic databases, grey literature and hand searching using specific search terms was conducted to identify relevant literature. Search results were subjected to a three-step selection process to ensure the inclusion criteria of this review were met. Statistical data pertaining to the accuracy, sensitivity, and specificity of the B-mode, CDS and combined B-mode CDS features were extracted. These results subsequently underwent a narrative analysis. RESULTS Five studies met the inclusion criteria. A variety of B-mode features were identified. Most studies showed that reliance on CDS alone can be prone to false-negative results. The combination of B-mode and CDS features were found to increase the overall sensitivity of ultrasound towards TT (up to 100% in 3 studies). All studies recommended correlation with clinical examination findings. Several limitations in methodology of the included studies were noted: small sample populations and lack of information on the experience of ultrasound practitioners. This highlighted the need for a primary study with a larger sample population to validate the findings of this review. CONCLUSION The combination of B-mode and CDS ultrasound is a useful and reliable triage tool in the detection of TT, particularly in equivocal or low suspicion cases but its findings should always be adjunct with clinical examination. Nevertheless, it is noted that appropriate service level agreements, pathways, and training are key factors in ensuring effectiveness of the process. IMPLICATIONS FOR PRACTICE Dedicated training and appropriate departmental protocol are key in ensuring accurate diagnosis across all levels of practice.
Collapse
Affiliation(s)
- P S M McLaren
- Royal Victoria Infirmary, The Newcastle upon Tyne Hospitals NHS Foundation Trust, Queen Victoria Road, NE1 4LP, Newcastle upon Tyne, United Kingdom.
| |
Collapse
|
24
|
Zheng WX, Hou GD, Zhang W, Wei D, Gao XL, Chen MH, Huang LG, Yan F, Zhang G, Yu L, Liu F, Zhang B, Yuan JL. Establishment and internal validation of preoperative nomograms for predicting the possibility of testicular salvage in patients with testicular torsion. Asian J Androl 2021; 23:97-102. [PMID: 32687070 PMCID: PMC7831831 DOI: 10.4103/aja.aja_31_20] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
This study aimed to establish nomograms to preoperatively predict the possibility of testicular salvage (TS) in patients with testicular torsion. The clinical data of 204 patients with testicular torsion diagnosed at Xijing Hospital and Tangdu Hospital (Xi'an, China) between August 2008 and November 2019 were retrospectively analyzed. Univariate and multivariate logistic regression analyses were used to determine the independent predictors of TS. Based on multivariate regression coefficients, nomograms to predict possibility of TS were established. The predictive ability of the nomograms was internally validated by receiver operating characteristic (ROC) curves and calibration plots. The duration of symptoms ranged from 2 h to 1 month, with a median of 3.5 days. Thirty (14.7%) patients underwent surgical reduction and contralateral orchiopexy, while the remaining 174 (85.3%) underwent orchiectomy and contralateral orchiopexy. Finally, long symptom duration was an independent risk predictor for TS, while visible intratesticular blood flow and homogeneous testicular echotexture under color Doppler ultrasound were independent protective predictors. Internal validation showed that the nomograms, which were established by integrating these three predictive factors, had good discrimination ability in predicting the possibility of TS (areas under the ROC curves were 0.851 and 0.828, respectively). The calibration plots showed good agreement between the nomogram-predicted possibility of TS and the actual situation. In conclusion, this brief preoperative prediction tool will help clinicians to quickly determine the urgency of surgical exploration.
Collapse
Affiliation(s)
- Wan-Xiang Zheng
- Department of Urology, Xijing Hospital, The Fourth Military Medical University, Xi'an 710032, China
| | - Guang-Dong Hou
- Department of Urology, Xijing Hospital, The Fourth Military Medical University, Xi'an 710032, China
| | - Wei Zhang
- Department of Urology, Tangdu Hospital, The Fourth Military Medical University, Xi'an 710038, China
| | - Di Wei
- Department of Urology, Xijing Hospital, The Fourth Military Medical University, Xi'an 710032, China
| | - Xue-Lin Gao
- Department of Urology, Xijing Hospital, The Fourth Military Medical University, Xi'an 710032, China
| | - Mei-Hong Chen
- Department of Urology, Xijing Hospital, The Fourth Military Medical University, Xi'an 710032, China
| | - Lu-Guang Huang
- Information Center, Xijing Hospital, The Fourth Military Medical University, Xi'an 710032, China
| | - Fei Yan
- Department of Urology, Xijing Hospital, The Fourth Military Medical University, Xi'an 710032, China
| | - Geng Zhang
- Department of Urology, Xijing Hospital, The Fourth Military Medical University, Xi'an 710032, China
| | - Lei Yu
- Department of Urology, Xijing Hospital, The Fourth Military Medical University, Xi'an 710032, China
| | - Fei Liu
- Department of Urology, Xijing Hospital, The Fourth Military Medical University, Xi'an 710032, China
| | - Bo Zhang
- Department of Urology, Tangdu Hospital, The Fourth Military Medical University, Xi'an 710038, China
| | - Jian-Lin Yuan
- Department of Urology, Xijing Hospital, The Fourth Military Medical University, Xi'an 710032, China
| |
Collapse
|
25
|
[Acute Idiopathic Scrotal Edema - A Relevant Differential Diagnosis of the Acute Scrotum in Childhood and Adolescence]. KLINISCHE PADIATRIE 2020; 233:59-62. [PMID: 33202426 DOI: 10.1055/a-1289-0142] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Zusammenfassung
Hintergrund Das „akute Skrotum“ ist ein häufiger kinderurologischer Notfall, der eine rasche Beurteilung zur Diagnose bzw. zum Ausschluss einer Hodentorsion erfordert. Zu den weniger bekannten Differenzialdiagnosen zählt das idiopathische Skrotalödem (AISE). In dieser Studie beschreiben wir Häufigkeit und klinisches Management des AISE in unserer Klinik.
Patienten 319 Patienten im Alter von 0 bis 17 Jahren, die zwischen 01/2013 bis 12/2017 in der kinderurologischen Klinik der KUNO-Kinderklinik St. Hedwig Regensburg mit der Diagnose „akutes Skrotum“ behandelt wurden.
Methode Retrospektive Analyse der Patientenakten.
Ergebnisse 234/319 Patienten wurden ambulant und 85/319 (27%) stationär behandelt. Bei 23/319 (7,2%) wurde ein AISE diagnostiziert. Alle Patienten mit AISE wurden ambulant behandelt, bei keinem dieser Patienten musste eine operative Exploration erfolgen. Weitere Diagnosen der ambulanten Patienten: Epididymitis (87/234; 37%), Hydatidentorsion (42/234; 18%), Hodentorsion (5/234; 2%) Hodentrauma (10/234; 4%), Hydrozele (9/234; 4%), unspezifische Hodenschmerzen (58/234; 25%). Diagnosen der stationären Patienten: Hodentorsion (58/85; 68%), Hydatidentorsion (17/85; 20%), Epididymitis (8/85; 9%), Hodentrauma (1/85; 1%), Tumor (1/85; 1%).
Diskussion Das AISE ist eine Ausschlussdiagnose mit typischem klinischem Bild. Zusammen mit dem charakteristischen Befund in der (Doppler-) Sonografie ist eine sichere Abgrenzung zu anderen Differenzialdiagnosen des akuten Skrotums möglich. Durch die korrekte Diagnosestellung können unnötige Klinikaufenthalte, Operationen und medikamentöse Behandlungen vermieden werden.
Schlussfolgerung Das AISE ist eine relevante Differentialdiagnose des akuten Skrotums, das Kinder- und Jugendärzten bekannt sein sollte.
Collapse
|
26
|
Sweet DE, Feldman MK, Remer EM. Imaging of the acute scrotum: keys to a rapid diagnosis of acute scrotal disorders. Abdom Radiol (NY) 2020; 45:2063-2081. [PMID: 31748822 DOI: 10.1007/s00261-019-02333-4] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
Imaging of the scrotum in the setting of acute symptoms such as pain or swelling is commonly performed emergently to differentiate between patients who require immediate surgery and those that do not. Acute scrotal symptoms are generally caused by infectious, traumatic or vascular etiologies. Rapid diagnosis and initiation of treatment is vital for testicular salvage in cases of acute testicular torsion, testicular rupture, and Fournier gangrene. Epididymitis, epididymo-orchitis, torsed testicular appendage, segmental testicular infarction, scrotal hematomas, testicular neoplasms, and acute idiopathic scrotal edema can have similar clinical presentations, but these conditions do not require immediate surgery. Ultrasound is the well-established first-line imaging modality for the acute scrotum. Contrast-enhanced ultrasound and magnetic resonance imaging can be useful as problem-solving tools when ultrasound studies are inconclusive or equivocal. This review describes normal scrotal anatomy and a wide range acute scrotal disorders, with emphasis on the imaging and clinical features that can minimize the risk of misdiagnosis.
Collapse
Affiliation(s)
- David E Sweet
- Section of Abdominal Imaging, Imaging Institute, Cleveland Clinic, 9500 Euclid Ave, Cleveland, OH, 44195, USA
| | - Myra K Feldman
- Section of Abdominal Imaging, Imaging Institute, Cleveland Clinic, 9500 Euclid Ave, Cleveland, OH, 44195, USA
| | - Erick M Remer
- Section of Abdominal Imaging, Imaging Institute, Cleveland Clinic, 9500 Euclid Ave, Cleveland, OH, 44195, USA.
- Glickman Urological and Kidney Institute, Cleveland Clinic, 9500 Euclid Ave, Cleveland, OH, 44195, USA.
| |
Collapse
|
27
|
Zhang X, Zhang J, Cai Z, Wang X, Lu W, Li H. Effect of unilateral testicular torsion at different ages on male fertility. J Int Med Res 2020; 48:300060520918792. [PMID: 32314623 PMCID: PMC7175056 DOI: 10.1177/0300060520918792] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Objective To investigate the effect of early-life unilateral testicular torsion on adult male fertility. Methods Clinical information was collected for 122 patients who had experienced unilateral testicular torsion at a median age of 15.5 years. The recent pregnancy rate and time to pregnancy experienced by the patients’ female partners were assessed by structured interviews. Data were analyzed by the chi-squared test and Student’s t-test. Results Seventy-two patients with testicular torsion met the criteria for inclusion in our analyses; 49 had undergone orchiectomy, while 23 had undergone surgical repositioning/orchiopexy. The pregnancy rate and median time to pregnancy were 83.67% (41/49) and 1.6 years, respectively, in the orchiectomy group, whereas they were 91.30% (21/23) and 0.75 years, respectively, in the repositioning/orchiopexy group. The recent pregnancy rate was higher in patients with torsion in childhood than in patients with torsion in adolescence; it was lowest in patients with torsion in adulthood. Surgical repositioning/orchiopexy yielded a significantly better recent pregnancy rate among the three groups, based on age at the time of torsion, and a shorter time to pregnancy than orchiectomy in patients with torsion in adolescence. Conclusion Onset of unilateral testicular torsion early in life has a negligible effect on adult male fertility.
Collapse
Affiliation(s)
- Xinyu Zhang
- Department of Urology, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, China.,Department of Urology, The Sixth Medical Centre, Chinese PLA General Hospital, Beijing, China
| | - Jianzhong Zhang
- Department of Urology, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, China
| | - Zhonglin Cai
- Department of Urology, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, China
| | - Xiyou Wang
- Department of Urology, The Sixth Medical Centre, Chinese PLA General Hospital, Beijing, China
| | - Wenhong Lu
- NHC Key Laboratory of Male Reproductive Health, National Research Institute for Family Planning & WHO Collaborating Center for Research in Human Reproduction, Beijing, China
| | - Hongjun Li
- Department of Urology, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, China
| |
Collapse
|
28
|
Vauth F, Vogel S, Hofmann A, Rösch WH. [Acute idiopathic scrotal edema-an underestimated differential diagnosis of acute scrotum]. Urologe A 2020; 59:266-270. [PMID: 32060579 DOI: 10.1007/s00120-020-01144-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Considering that Quist et al. first described the acute idiopathic scrotal edema (AISE) already in 1956, there are not many studies published in literature concerning the etiology, the development, and the progress of the disease since then. According to the literature the incidence of AISE is about 20%. Although it is an important differential diagnosis for acute scrotum, it remains extensively unknown. Therefore, AISE should be kept in mind by urologists, pediatric surgeons and pediatricians to avoid needless surgery or antibiotic therapy.
Collapse
Affiliation(s)
- F Vauth
- Klinik für Kinderurologie in Kooperation mit der Universität Regensburg, KUNO-Klinik St. Hedwig, Steinmetzstraße 1-3, 93049, Regensburg, Deutschland.
| | - S Vogel
- Klinik für Kinderurologie in Kooperation mit der Universität Regensburg, KUNO-Klinik St. Hedwig, Steinmetzstraße 1-3, 93049, Regensburg, Deutschland
| | - A Hofmann
- Klinik für Kinderurologie in Kooperation mit der Universität Regensburg, KUNO-Klinik St. Hedwig, Steinmetzstraße 1-3, 93049, Regensburg, Deutschland
| | - W H Rösch
- Klinik für Kinderurologie in Kooperation mit der Universität Regensburg, KUNO-Klinik St. Hedwig, Steinmetzstraße 1-3, 93049, Regensburg, Deutschland
| |
Collapse
|
29
|
Shun-Ping CMD, Bin CMD. Absent Blood Flow in the Testis on Color Doppler Ultrasound: The Causes, Differential Diagnosis and Clinical Value. ADVANCED ULTRASOUND IN DIAGNOSIS AND THERAPY 2020. [DOI: 10.37015/audt.2020.190035] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
|
30
|
Hosokawa T, Takahashi H, Tanami Y, Sato Y, Ishimaru T, Tanaka Y, Kawashima H, Oguma E, Yamada Y. Diagnostic Accuracy of Ultrasound for the Directionality of Testicular Rotation and the Degree of Spermatic Cord Twist in Pediatric Patients With Testicular Torsion. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2020; 39:119-126. [PMID: 31268182 DOI: 10.1002/jum.15084] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/17/2019] [Revised: 05/31/2019] [Accepted: 06/13/2019] [Indexed: 06/09/2023]
Abstract
OBJECTIVES To evaluate the diagnostic accuracy of ultrasound (US) to diagnose the directionality of testicular rotation and the degree of spermatic cord twist in pediatric patients with testicular torsion. METHODS A retrospective review of 14 pediatric patients with testicular torsion was conducted. The directionality of testicular rotation was classified as an inner or outer direction (inner, counterclockwise in the left testis [viewed from below] and clockwise in the right testis; and outer, counterclockwise in the right testis and clockwise in the left testis). The Clopper-Pearson method and the Fisher exact, Mann-Whitney U, and Wilcoxon signed rank sum tests were used for the statistical analyses. RESULTS The diagnostic accuracy of US in the directionality of testicular rotation and the degree of spermatic cord twist were 78.6% (11 of 14; 95% confidence interval, 49.2%-95.3%) and 36.4% (4 of 11; 95% confidence interval, 10.9%-69.2%), respectively. Outer rotation was seen in 50.0% of the cases. The directionality of testicular rotation and the degree of spermatic cord twist as determined by US were not significantly different between the patients with salvaged testis and those with testicular loss (inner/outer direction, 4/2 versus 4/4; P = .627; mean twist ± SD, 330.0° ± 73.5° versus 337.5° ± 115.4°; P > .999). There was no significant difference in the degree of spermatic cord twist determined by US and surgical results (343.0° ± 97.1° versus 458.2° ± 168.2°; P = .063). CONCLUSIONS The accuracy of US in determining the directionality of testicular rotation was relatively high in our small cohort. This information may be useful for pediatric surgeons and urologists when performing early manual reduction for testicular torsion.
Collapse
Affiliation(s)
- Takahiro Hosokawa
- Departments of Radiology, Saitama Children's Medical Center, Saitama, Japan
| | - Hiroaki Takahashi
- Department of Diagnostic and Interventional Radiology, University of Tsukuba Hospital, Tsukuba, Japan
| | - Yutaka Tanami
- Departments of Radiology, Saitama Children's Medical Center, Saitama, Japan
| | - Yumiko Sato
- Departments of Radiology, Saitama Children's Medical Center, Saitama, Japan
| | | | - Yujiro Tanaka
- Department of Pediatric Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | | | - Eiji Oguma
- Departments of Radiology, Saitama Children's Medical Center, Saitama, Japan
| | - Yoshitake Yamada
- Department of Radiology, Keio University School of Medicine, Tokyo, Japan
| |
Collapse
|
31
|
Wang CL, Aryal B, Oto A, Allen BC, Akin O, Alexander LF, Bardo DM, Chong J, Froemming AT, Fulgham PF, Heller MT, Maranchie JK, Mody RN, Patel BN, Schieda N, Turkbey IB, Venkatesan AM, Yoo DC, Lockhart ME. ACR Appropriateness Criteria® Acute Onset of Scrotal Pain-Without Trauma, Without Antecedent Mass. J Am Coll Radiol 2019; 16:S38-S43. [DOI: 10.1016/j.jacr.2019.02.016] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2019] [Accepted: 02/08/2019] [Indexed: 10/26/2022]
|
32
|
Ota K, Fukui K, Oba K, Shimoda A, Oka M, Ota K, Sakaue M, Takasu A. The role of ultrasound imaging in adult patients with testicular torsion: a systematic review and meta-analysis. J Med Ultrason (2001) 2019; 46:325-334. [DOI: 10.1007/s10396-019-00937-3] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2019] [Accepted: 02/18/2019] [Indexed: 10/27/2022]
|
33
|
Gu X, Yang M, Liu Y, Liu F, Liu D, Shi F. The ultrasonic whirlpool sign combined with plasma d-dimer level in adnexal torsion. Eur J Radiol 2018; 109:196-202. [DOI: 10.1016/j.ejrad.2018.08.025] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2018] [Revised: 07/09/2018] [Accepted: 08/26/2018] [Indexed: 10/28/2022]
|
34
|
Lesions Without Borders: Scrotal Lesions That Involve Both the Intratesticular and Extratesticular Regions. AJR Am J Roentgenol 2018; 210:W70-W79. [PMID: 29355401 DOI: 10.2214/ajr.17.18369] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
OBJECTIVE Differentiation of scrotal lesions is often dictated by whether they are intraor extratesticular. However, these regions are not entirely isolated, and disease processes can span both spaces. We review a variety of lesions that can involve both regions, describe the relevant anatomy, and illustrate their imaging appearances. CONCLUSION Identification of involvement of both intra- and extratesticular regions by a single process can narrow the differential considerations and help arrive at the correct diagnosis.
Collapse
|
35
|
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
|
36
|
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
|
37
|
Bandarkar AN, Blask AR. Testicular torsion with preserved flow: key sonographic features and value-added approach to diagnosis. Pediatr Radiol 2018; 48:735-744. [PMID: 29468365 PMCID: PMC5895684 DOI: 10.1007/s00247-018-4093-0] [Citation(s) in RCA: 66] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/10/2017] [Revised: 01/02/2018] [Accepted: 01/19/2018] [Indexed: 11/30/2022]
Abstract
Testicular sonography has contributed greatly to the preoperative diagnosis of testicular torsion in the pediatric patient and is the mainstay for evaluation of acute scrotal pain. Despite its high sensitivity and specificity, both false-negative and false-positive findings occur. Presence of documented Doppler flow within the testis might be a dissuading factor for surgical exploration with resultant testicular loss in the false-negative cases. Our goal is to illustrate key sonographic features in the spectrum of testicular torsion with preserved testicular flow, and to describe how to differentiate testicular torsion from epididymitis in order to avoid the under-diagnosis of testicular torsion. We simplify the anatomy of the bell clapper testis. We also describe our sonographic protocol for testicular torsion and share valuable tips from our approach to challenging cases.
Collapse
Affiliation(s)
- Anjum N. Bandarkar
- Department of Radiology, Mid-Atlantic Permanente Medical Group, 1890 Metro Center Drive, Reston, VA 20190 USA
| | - Anna R. Blask
- Department of Radiology, Children’s National Health System, Washington, DC USA
| |
Collapse
|
38
|
Chang CD, Lin JW, Lee CC, Chen YT, Huang CC, Lee YW, Ng SH, Ko SF. Acute Epididymo-orchitis-Related Global Testicular Infarction: Clinical and Ultrasound Findings With an Emphasis on the Juxta-epididymal String-of-Bead Sign. Ultrasound Q 2017; 32:283-9. [PMID: 27556195 DOI: 10.1097/ruq.0000000000000225] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Acute epididymo-orchitis (AEO)-related global testicular infarction (GTI) is rare. We report herein the clinical and ultrasound findings of 6 patients with AEO-related GTI. Seventeen patients with torsion-related GTI were also reviewed and compared. The echotexture of AEO-related GTI ranged from mildly inhomogeneous to diffuse heteroechoic, depending on the severity of testicular necrotic changes. All of the patients showed a juxta-epididymal string-of-bead pattern on color Doppler ultrasound, which was ascribed to patent arteries (5/6, 87%) and collateral vessels (1/6, 13%) in the tunica albuginea. There were no significant differences in age, laterality, leukocyte count, testicular volume ratio (infarcted/normal), frequencies of heteroechoic testicular parenchyma, scrotal skin thickening, and hydrocele between the 2 groups. However, the left testis was predominantly affected in both groups. Compared with torsion-related GTI, patients with AEO-related GTI had significantly longer duration from scrotal pain onset to surgery (13.5 ± 5.2 vs 2.6 ± 2.0 days, P < 0.001), a higher level of serum C-reactive protein (110.0 ± 82.0 vs 41.2 ± 35.9 mg/dL, P = 0.013), a higher frequency of the juxta-epididymal string-of-bead sign (100% vs 12%, P < 0.001), and a lower frequency of the whirlpool/knot sign (0% vs 88%, P = 0.002). Although the testis in AEO-related GTI may appear variable from mildly to extensively heteroechoic on gray-scale ultrasound, this unusual disease can be characterized by an avascular testis with a juxta-epididymal string-of-bead sign on color Doppler ultrasound.
Collapse
Affiliation(s)
- Ching-Di Chang
- *Departments of Radiology and †Pathology, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine; ‡Department of Biomedical Engineering, I-Shou University; and §Division of Urology, Department of Surgery, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan, Republic of China
| | | | | | | | | | | | | | | |
Collapse
|
39
|
Kitami M. Ultrasonography of pediatric urogenital emergencies: review of classic and new techniques. Ultrasonography 2017; 36:222-238. [PMID: 28494525 PMCID: PMC5494863 DOI: 10.14366/usg.17011] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2017] [Revised: 03/18/2017] [Accepted: 03/30/2017] [Indexed: 12/28/2022] Open
Abstract
Urogenital emergencies are fairly common in the pediatric population, and a timely and correct diagnosis is necessary to avoid possible future infertility. In this field, ultrasonography is essential, as it has the advantages of being radiation-free and readily accessible. In particular, a high-frequency transducer allows precise evaluation of the morphology and vascularity of the scrotum, which is on the surface of the body. Beyond conventional techniques, new advanced imaging techniques have been developed, including elastography and contrast-enhanced ultrasonography. However, several pitfalls remain in the diagnosis of urogenital diseases using ultrasonography. Thus, accurate knowledge and sufficient experience with the technique are essential for making a correct diagnosis. This review provides an overview of pediatric urogenital emergency pathologies and recent ultrasonography techniques.
Collapse
Affiliation(s)
- Masahiro Kitami
- Department of Diagnostic Radiology, Tohoku University Graduate School of Medicine, Sendai, Japan
| |
Collapse
|
40
|
Weatherspoon K, Polansky S, Catanzano T. Ultrasound Emergencies of the Male Pelvis. Semin Ultrasound CT MR 2017; 38:327-344. [PMID: 28865524 DOI: 10.1053/j.sult.2017.02.002] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
Male pelvic emergencies are uncommon, and symptoms typically include scrotal pain, scrotal enlargement, or a palpable scrotal mass or all of these. Ultrasound is often the first-line modality for evaluation of male pelvic emergencies, which may be stratified into vascular, infectious, or traumatic causes. Entities such as testicular torsion, Fournier gangrene, and testicular dislocation are surgical emergencies and should not be missed or misdiagnosed, as this may cause a significant delay in urgently necessary treatment. Radiologists need to be familiar with the role of imaging as well as the key characteristic imaging findings of these injuries to direct the appropriate management.
Collapse
Affiliation(s)
- Kimberly Weatherspoon
- Department of Radiology, Radiology resident Baystate Medical Center, University of Massachusetts, Springfield, MA.
| | - Stanley Polansky
- Department of Radiology, Assistant Professor Baystate Medical Center, University of Massachusetts, Springfield, MA
| | - Tara Catanzano
- Department of Radiology, Program Director Radiology Residency Program, Baystate Medical Center, University of Massachusetts, Springfield, MA
| |
Collapse
|
41
|
Abstract
Non contrast helical computed tomography (CT) study of the abdomen is frequently performed in evaluation of suspected ureteric colic. We present CT images of a young adult male patient who had torsion of an undescended, non-neoplastic testis and describe the “Inguinoscrotal whirlpool sign on CT”.
Collapse
Affiliation(s)
- Venkatraman Indiran
- Department of Radiodiagnosis, Sree Balaji Medical College and Hospital, Chennai, Tamil Nadu, India
| |
Collapse
|
42
|
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.
Collapse
|
43
|
Fehér ÁM, Bajory Z. A review of main controversial aspects of acute testicular torsion. JOURNAL OF ACUTE DISEASE 2016. [DOI: 10.1016/j.joad.2015.06.017] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022] Open
|
44
|
Bertolotto M, Cantisani V, Valentino M, Pavlica P, Derchi LE. Pitfalls in Imaging for Acute Scrotal Pathology. Semin Roentgenol 2016; 51:60-9. [DOI: 10.1053/j.ro.2016.02.012] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
|
45
|
[Scrotal ultrasound examinations in infants and toddlers]. Urologe A 2015; 55:3-9. [PMID: 26659829 DOI: 10.1007/s00120-015-0009-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
BACKGROUND Besides physical examination, ultrasonography is the most valuable diagnostic tool to assess the scrotum and testes in the case of an acute scrotum or scrotal pathology. PROBLEMS In infants and toddlers the examination can be challenging. Due to the limited patient compliance, the small testicular size (< 0.5 ml), and low blood flow velocity (< 3 cm/s), it can be difficult to achieve a proper flow curve when assessing blood flow. CONCLUSION The examiner's skills are as important as adequate equipment (i. e., linear ultrasound probe, 12-14 MHz) and optimal program settings (Doppler scale < 3 cm/s, gate 1 mm). However, if there is doubt, surgical exploration is unavoidable.
Collapse
|
46
|
Agrawal AM, Tripathi PS, Shankhwar A, Naveen C. Role of ultrasound with color Doppler in acute scrotum management. J Family Med Prim Care 2015; 3:409-12. [PMID: 25657954 PMCID: PMC4311353 DOI: 10.4103/2249-4863.148130] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
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.
Collapse
Affiliation(s)
- Alka M Agrawal
- Department of Radiodiagnosis, Mahatma Gandhi Memorial Medical College and Maharaja Yeshwantrao Hospital, Indore, Madhya Pradesh, India
| | - Prem Siddharth Tripathi
- Department of Radiodiagnosis, Mahatma Gandhi Memorial Medical College and Maharaja Yeshwantrao Hospital, Indore, Madhya Pradesh, India
| | - Amit Shankhwar
- Department of Radiodiagnosis, Mahatma Gandhi Memorial Medical College and Maharaja Yeshwantrao Hospital, Indore, Madhya Pradesh, India
| | - C Naveen
- Department of Radiodiagnosis, Mahatma Gandhi Memorial Medical College and Maharaja Yeshwantrao Hospital, Indore, Madhya Pradesh, India
| |
Collapse
|
47
|
Abstract
Sonography is the ideal modality for evaluation and characterization of a scrotal mass. Extratesticular masses are usually benign, whereas intratesticular masses are generally malignant until proved otherwise. However, it is important to recognize the benign intratesticular conditions, thus possibly preventing orchiectomy when unwarranted, while appreciating the more significant findings of extratesticular masses that may warrant further intervention. This article reviews the anatomy and sonographic findings of scrotal masses. Normal anatomy, general imaging techniques, and assessment of intratesticular and extratesticular disorders will be discussed.
Collapse
|
48
|
Esposito F, Di Serafino M, Mercogliano C, Vitale V, Sgambati P, Vallone G. The "whirlpool sign", a US finding in partial torsion of the spermatic cord: 4 cases. J Ultrasound 2014; 17:313-5. [PMID: 25368691 DOI: 10.1007/s40477-014-0095-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2013] [Accepted: 11/15/2013] [Indexed: 10/25/2022] Open
Affiliation(s)
- Francesco Esposito
- Department of Radiology, Santobono Children's Hospital, Via Mario Fiore 6, 80123, Naples, Italy
| | - Marco Di Serafino
- Department of Radiology, Santa Maria alla Gruccia Hospital, Azienda USL8 Arezzo, Montevarchi, AR Italy
| | | | - Valerio Vitale
- Department of Radiology, University Hospital Federico II, Naples, Italy
| | - Paolo Sgambati
- Department of Radiology, Santa Maria alla Gruccia Hospital, Azienda USL8 Arezzo, Montevarchi, AR Italy
| | | |
Collapse
|
49
|
Osman S, Zaidi SF, Lehnert BE, Linnau KF. Core curriculum illustration: testicular torsion. Emerg Radiol 2014; 21:321-3. [PMID: 24578061 DOI: 10.1007/s10140-014-1205-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2014] [Accepted: 02/10/2014] [Indexed: 10/25/2022]
Abstract
This is the 7th 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.aseronline.org/curriculum/toc.htm .
Collapse
Affiliation(s)
- Sherif Osman
- Department of Radiology, Harborview Medical Center, University of Washington, Box 359 728, 325 Ninth Ave, Seattle, WA, 98104-2499, USA
| | | | | | | |
Collapse
|
50
|
Shaher HM, Alzahrani AS, Alshaalan HM. Unusual Testicular Ultrasound Findings in a Child with Henoch-Schönlein Purpura. J Med Ultrasound 2013. [DOI: 10.1016/j.jmu.2013.10.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022] Open
|