Color Doppler Sonography of Normal and Torsed Testicular Appendages in Children

Baldisserotto, Matteo; Souza, João Carlos Ketzer de; Pertence, Ana Paula; Dora, Marcelo Dourado

doi:10.2214/ajr.184.4.01841287

Cited by 85 publications

(46 citation statements)

References 11 publications

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“…1 Of these 4 structures, the appendix testis is the most frequently encountered, with a prevalence of 83% to 92%; the appendix epididymis is the next most common, with a prevalence of 20%. 6,7 These 2 structures are the most likely to undergo torsion. 5 Intrascrotal appendages twist around their own peduncles.…”

Section: Discussionmentioning

confidence: 99%

Manual Reduction of Torsion of an Intrascrotal Appendage Under Ultrasonographic Monitoring

Park

Lee

et al. 2007

Journal of Ultrasound in Medicine

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Objective. The purpose of this study was to evaluate the feasibility and safety of manual reduction of torsion of an intrascrotal appendage under ultrasonographic monitoring. Methods. Fifteen boys with torsion of an intrascrotal appendage, confirmed by scrotal ultrasonography and clinical status, were included in the study. The boys were 6 to 13 years old (mean age, 9 years). They all had painful, unilateral swelling of the scrotum and a palpable, tender nodule on physical examination. Scrotal ultrasonography indicated a single, variably echoic mass corresponding to the intrascrotal appendage. The mass was avascular according to Doppler ultrasonography. Thirteen boys underwent manual reduction under ultrasonographic monitoring. We tried to pull and release the swollen appendage in 8 patients and gently squeezed the appendage in 5. The procedure was considered successful when ultrasonography showed reperfusion in the appendage and the patients stated complete relief of scrotal pain. In 14 boys, follow-up scrotal ultrasonography was performed after the manual reduction. Results. Successful reduction was obtained in 12 (80.0%) of 15 boys. Only 1 boy was regarded as having reduction failure; this patient had intractable pain after the trial reduction, and ultrasonography showed transient vascular flow that promptly disappeared in the appendage. On follow-up ultrasonography, the maximal diameter ± SD of the intrascrotal appendages significantly decreased from 6.1 ± 1.2 to 4.0 ± 1.3 (P = .005) in 11 patients with successful reduction. Conclusions. Manual reduction under ultrasonographic monitoring seems to be a feasible and effective method for the treatment of torsion of an intrascrotal appendage to immediately relieve pain. Key words: scrotum; torsion; ultrasonography. Hospital, 1174 Jung-dong, Wonmi-gu, Bucheon-si, Gyeonggi-do 420-021, Korea. E-mail: indawn@schbc.ac.kr he most common cause of an acute painful hemiscrotum in children is torsion of an intrascrotal appendage, which accounts for 35% to 67% of cases and is generally considered more common than testicular torsion.1 The ultrasonographic findings of torsion of an intrascrotal appendage are a spherical appendage of 5 mm or larger, increased periappendiceal blood flow, and no blood flow within the torsed appendage.2,3 The internal echogenicity of a torsed intrascrotal appendage is variable, appearing hypoechoic, isoechoic, and hyperechoic to the testis. Clinical findings for establishing a diagnosis are a blue dot visible through the scrotal skin (a blue dot sign), a black dot shown by transillumination, and a tender, palpable

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Section: Discussionmentioning

confidence: 99%

Manual Reduction of Torsion of an Intrascrotal Appendage Under Ultrasonographic Monitoring

Park

Lee

et al. 2007

Journal of Ultrasound in Medicine

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“…The clinical history may be identical to torsion of the spermatic cord; however, classically the examination findings describe a superiorly located ''blue spot'', an uncommon finding seen in only 23 % of cases [15]. Sonographic appearances are variable with reports suggesting an enlarged appendix testis ([5.6 mm) with an absence of colour Doppler signal characteristic [16,17] (Fig. 3).…”

Section: Torsion Of the Appendix Testismentioning

confidence: 99%

A review of ultrasound imaging in scrotal emergencies

Yusuf

Sidhu

2013

J Ultrasound

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Scrotal emergencies represent a small proportion of admissions to the emergency department; however, the intimate nature and potential for serious outcome often cause great anxiety. Rapid assessment is required to exclude fertility-threatening conditions and expedite surgical management. Ultrasound is an essential tool in acute scrotal assessment as it allows rapid, radiation-free, highresolution imaging and, importantly, assessment of vascularity with colour Doppler imaging. In the presentation of the acute scrotum, the ''on-call'' practitioner will frequently be asked to exclude pathology requiring surgical management, in particular torsion of the spermatic cord. To provide an accurate evaluation the individual is required to have an understanding of scrotal anatomy, sonographic technique and recognition of pathology. This review article will familiarise the reader with the sonographic findings of common acute scrotal pathology.Sommario Le emergenze scrotali rappresentano una piccola percentuale di accessi al pronto soccorso, ma la natura intima e la possibilità di esiti seri sono spesso causa di grande ansia. E' necessaria una valutazione rapida, al fine di escludere condizioni di pericolo per la fertilità e accelerare il trattamento chirurgico. L'ecografia è uno strumento essenziale per la valutazione dello scroto acuto in quanto rapida, esente da radiazione, ad alta risoluzione e, soprattutto, permette la valutazione della vascolarizzazione con colour Doppler. Nello scroto acuto l'ecografista spesso verrà chiamato a escludere patologie che richiedono un trattamento chirurgico, in particolare la torsione del funicolo spermatico. Al fine di fornire una valutazione precisa è tenuto ad avere una conoscenza dell'anatomia scrotale, della tecnica ecografica e a conoscere le varie patologie. Questo articolo di revisione ha lo scopo di familiarizzare il lettore con gli aspetti ecografici della patologia scrotale acuta più frequente.

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“…In evolution the appendage becomes hyperechoic, secondary to calcium depositions and it can spontaneously detach [16]. A testicular appendage >5.6 mm without vascular signal is suggestive for appendage torsion [17]. The role of CEUS in the evaluation of testicular appendage torsion has not been yet described in literature.…”

Section: Figmentioning

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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Color Doppler Sonography of Normal and Torsed Testicular Appendages in Children

Abstract: The identification of a testicular appendage larger than 5.6 mm is suggestive of torsion. Therefore, depending on the patients' clinical conditions, these cases can be treated conservatively when an appendage larger than 5.6 mm is identified.

Cited by 85 publications

References 11 publications

Manual Reduction of Torsion of an Intrascrotal Appendage Under Ultrasonographic Monitoring

Manual Reduction of Torsion of an Intrascrotal Appendage Under Ultrasonographic Monitoring

A review of ultrasound imaging in scrotal emergencies

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

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