Imaging of the acute scrotum: is there a place for contrast-enhanced ultrasonography?

Moschouris, Hippocrates; Stamatiou, Konstantinos; Lampropoulou, E.; Kalikis, D.; Matsaidonis, Dimitrios

doi:10.1590/s1677-55382009000600008

Cited by 57 publications

(48 citation statements)

References 21 publications

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“…Moschouris et al [13] examined a series of 19 patients with a painful scrotum, 6 of whom had a history of trauma, concluding that there was not a significant advantage over conventional colour Doppler ultrasound. However the assessment of perfusion and tissue viability was not an important goal of the study.…”

Section: Hedayati M E Sellars D M Sharma and P S Sidhumentioning

confidence: 99%

Contrast-enhanced ultrasound in testicular trauma: role in directing exploration, debridement and organ salvage

Hedayati¹,

Sellars²,

Sharma³

et al. 2012

BJR

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ABSTRACT. We describe the use of contrast-enhanced ultrasound as an additional imaging technique during an ultrasound examination of a traumatised testis, allowing for confident testicular preserving surgery to be performed. Testicular trauma often arises as a consequence of a road traffic accident, a sporting mishap or a straddle injury. It tends to affect the younger male, in whom preservation of the testis is an important consideration. Clinical examination is difficult in the acute setting where establishment of the need for early surgical exploration is important and is notoriously inaccurate. Often greyscale ultrasound with the addition of colour Doppler techniques is the most useful investigation tool, readily identifying the appearance of testicular injury and so establishing the need for surgical exploration [1]. The appearances of testicular fracture, rupture, haematoma and haematocoele are readily identified on sonography, giving the surgeon a clear understanding of the status of the injury to the scrotal content and the need for exploration [2]. The establishment of continued blood flow to the injured testis has traditionally been based on the presence of colour Doppler signal; enabling the surgeon to tailor the surgery to either perform an orchidectomy or plan organ-sparing surgery. However, colour Doppler techniques have limitations; operator experience, movement artefact, patient discomfort and tissue reflectivity all play a part in diminishing the accuracy of the technique [3]. The use of contrastenhanced ultrasound (CEUS) is firmly established in many organs in the body, but less widely used in the testis [4]. CEUS is an ideal technique to ascertain the vascular supply to an organ, as the contrast agent is purely an intravascular agent and increases the sensitivity of detection of blood flow.We describe the use of CEUS as a tool for precise assessment of viable testicular tissue post-scrotal trauma, allowing a rapid and precise delineation of viable testicular tissue enabling organ-sparing treatment in testicular trauma. Case historyA 39-year-old male presented to the accident and emergency department following trauma to the right testis. The injury was sustained during a cricket match, when the patient collided with the wicket whilst fielding, not wearing any gonadal protection. There was no relevant medical or drug history and the patient was otherwise fit and well. On examination the right testis was swollen and tender, with difficulty in ascertaining the status of the contents of the scrotal sac. Observations were stable; blood biochemistry and haematology were unremarkable. An ultrasound examination was requested. An ultrasound examination was performed using a Siemens S2000 (Siemens, Mountain View, CA), with a linear array high frequency 9L4 transducer, with settings suitable for a scrotal examination. The left testis was unremarkable. The contour of superior pole of the right testis was ill-defined and suggestive of a tunica albuginea

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Section: Hedayati M E Sellars D M Sharma and P S Sidhumentioning

confidence: 99%

Contrast-enhanced ultrasound in testicular trauma: role in directing exploration, debridement and organ salvage

Hedayati¹,

Sellars²,

Sharma³

et al. 2012

BJR

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“…The contrast media is administered intravenous (2.4-4.8 ml), followed by a 10 ml saline solution bolus. After approximately 20 seconds, the microbubbles reach the intravascular space of the testis and may be visualized in the testicle up to 2-3 minutes after administration, then the intensity progressively decreases (wash-out phenomenon) [2][3][4][5]. CEUS presents an added diagnosis value in the acute pathology of the scrotum, being superior to non-contrast US, with a sensitivity (Se) and a specificity (Sp) up to 95% and 100, respectively (ultrasound has an 76% Se and a 45 Sp) [2].…”

Section: Introductionmentioning

confidence: 99%

Contrast enhanced harmonic ultrasonography for the evaluation of acute scrotal pathology. A pictorial essay.

et al. 2016

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Conventional ultrasonographic evaluation (grey scale and Doppler) represents the first line investigation in the acute pathology of the scrotum. Its diagnosis value in acute scrotal pathology is undoubted in regard with hypervascular lesions, but in the evaluation of isoechoic and hypo/avascular lesions i.v. contrast-enhanced harmonic ultrasonography (CEUS) is recommended in establishing a firm and certain diagnosis. Besides these, CEUS has an important role in the evaluation of the remaining viable testicular tissue in cases of testicular trauma, thus guiding a limited excision surgery. This paper aims to discuss the added diagnosis value of CEUS and to illustrate this through various ultrasonographic images suggestive for acute scrotum pathology.

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“…[32]. To our knowledge, there are no reports in the literature on the use of CEUS to evaluate blunt scrotal trauma (with the exception of a few anecdotal reports, including some by our group [14,18,20]. Valentino et al [20] reported on the use of CEUS for emergency work-up of scrotal pathology.…”

Section: Discussionmentioning

confidence: 89%

“…Early reports on the use of CEUS in the work-up of scrotal pathology indicated that it could be used to identify abscesses and areas of necrosis, which appear as nonenhanced areas [13,14]; to document increases in the mean contrast-medium transit time in the presence of a varicocele [15]; to evaluate tumor vascularization [16]; to facilitate extraction of sperm from infertile patients (by pinpointing better perfused areas of the gonad) [17]; and to characterize and follow-up ambiguous cases of segmental ischemia [18]. Testicular trauma could thus represent a new field of application for CEUS.…”

Section: Discussionmentioning

confidence: 99%

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Contrast-enhanced sonography in blunt scrotal trauma

Lobianco

Regine

Siero

et al. 2011

Journal of Ultrasound

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The scope of this study was to determine whether contrast-enhanced ultrasonography (CEUS), compared with basic US, can increase diagnostic confidence and provide relevant information on blunt scrotal trauma. Over a period of 75 months we examined 40 patients seen consecutively for blunt scrotal trauma using high-resolution US, color-power Doppler, low mechanical index CEUS, and power Doppler after IV administration of contrast medium (SonoVue Ò ). In the 24 cases that were positive, concordance between basal US and CEUS findings was grade 0 (absent) in 4 cases, grade 1 (low) in 3, grade 2 (moderate) in 8, and grade 3 (high) in 9. The relevance of the additional information provided by CEUS was classified as follows: high in 4/40 (10%), moderate 7/40 (17,5%), low 13/40 (32,5%), none in 14/40 (35%). Our findings demonstrate that CEUS is appreciably more sensitive in detecting damage caused by blunt scrotal trauma, particularly small lesions. It is also useful for differential diagnosis and marginalization of corpuscular fluid collections, fractures, and above all ruptures, which require immediate surgery. In our series 2 out of 3 (67%) patients with testicular rupture were diagnosed only by CEUS. We feel that the use of CEUS can significantly improve diagnostic confidence in cases of closed scrotal trauma although these conclusions need to be confirmed in larger case series.Sommario Scopo del nostro lavoro è stato di valutare l'eventuale maggiore confidenza diagnostica e contenuto informativo dell'ecografia con mezzo di contrasto e.v. (CEUS) nel trauma scrotale chiuso rispetto all'indagine ecografica (US) di base. Nell'arco di 75 mesi abbiamo esaminato 40 pazienti consecutivi con trauma scrotale chiuso, utilizzando US ad alta risoluzione, color-power-Doppler basale, ecocontrastografia a basso indice meccanico, power Doppler dopo mdc e.v. Il mdc usato è stato il SonoVue Ò . Nei 24 casi positivi, la concordanza tra US basale e CEUS è stata di grado 0 (assente) in 4 casi, di grado 1 (bassa) in 3, di grado 2 (medio) in 8, di grado 3 (elevato) in 9. La rilevanza del contenuto informativo aggiuntivo della * Award for the best oral presentation at the XXII SIUMB National Congress.* Corresponding author. Radiology Department, Santa Maria delle Grazie Hospital, Pozzuoli, Naples, Italy. E-mail address: robertolobianco@virgilio.it (R. Lobianco).Available online at www.sciencedirect.com CEUS veniva ritenuta: elevata in 4/40 (10%), media 7/40 (17,5%), bassa 13/40 (32,5%), assente in 14/40 (35%). I nostri risultati mostrano che la CEUS migliora sensibilmente la detezione dei segni di trauma rispetto l'US basale, specialmente nelle piccole lesioni. Essa è inoltre importante nella diagnosi differenziale e marginalizzazione delle raccolte fluide corpuscolate, nelle fratture e, di grande evidenza, nelle rotture, che impongono l'immediato intervento chirurgico: nella nostra casistica 2 casi su 3 di rotture (67%) si sono resi evidenti soltanto alla CEUS. Riteniamo che l'uso della CEUS possa aumentare significativamente la co...

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Imaging of the acute scrotum: is there a place for contrast-enhanced ultrasonography?

Cited by 57 publications

References 21 publications

Contrast-enhanced ultrasound in testicular trauma: role in directing exploration, debridement and organ salvage

Contrast-enhanced ultrasound in testicular trauma: role in directing exploration, debridement and organ salvage

Contrast enhanced harmonic ultrasonography for the evaluation of acute scrotal pathology. A pictorial essay.

Contrast-enhanced sonography in blunt scrotal trauma

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