Role of ultrasound with color doppler in acute scrotum management

Agrawal, Alka; Tripathi, Prem Siddharth; Shankhwar, Amit; Naveen, Chawla

doi:10.4103/2249-4863.148130

Cited by 23 publications

(9 citation statements)

References 11 publications

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“…The sensitivity found in this study of 78.8% is in line with that reported in other studies while the specificity we found of 98.1% is a little higher than previously reported. 1,[7][8][9] While our means of calculating the sensitivity and specificity were suboptimal (as discussed further below), it is notable that ultrasound was both more sensitive and more specific for epididymo-orchitis than UA. Given that ultrasound is the primary means of diagnosing all sorts of other scrotal pathology (testicular torsion, testicular tumors, hydroceles, etc.…”

Section: Discussionmentioning

confidence: 99%

“…Ultrasound is the diagnostic test of choice to evaluate acute scrotal pain. 1 In fact, the company that employs the emergency medicine physicians at the involved institution for this study mandates that its providers order a testicular ultrasound or consult a urologist on any patient with testicular pain. In addition to ultrasound, many experts [2][3][4] recommend a urinalysis (UA) as a routine diagnostic test for patients with scrotal pain primarily because of its purported ability to help diagnose and possibly treat epididymitis.…”

Section: Introductionmentioning

confidence: 99%

“…Using surrogate gold standards, prior studies have estimated the sensitivity of ultrasound for epididymo-orchitis to be from 69% to 93% and the specificity to be from 86% to 92%. 1,[7][8][9] The test characteristics of UA for epididymoorchitis are uncertain.…”

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

<p>Assessing the Utility of Ultrasound and Urinalysis for Patients with Possible Epididymo-Orchitis – A Retrospective Study</p>

Zitek

Ahmed

Lim

et al. 2020

OAEM

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Purpose: Many experts recommend ordering an ultrasound and a urinalysis on all patients with scrotal pain. While the ultrasound may help diagnose a number of potential causes of scrotal pain, the urinalysis primarily has value in assessing for epididymo-orchitis. This study sought to evaluate the utility of these diagnostic tests for patients who presented to the emergency department (ED) with acute scrotal pain and possible epididymo-orchitis. Patients and Methods: This was a single-center chart review of patients presenting to the ED with scrotal pain. Trained research assistants reviewed charts to obtain urinalysis and ultrasound results as well as diagnoses and treatments provided. Using the final diagnosis as a gold standard, the sensitivity and specificity of ultrasound and urinalysis were calculated for the diagnosis of epididymo-orchitis. Also, through a prespecified definition of "changed management," we estimated the percentage of cases in which a urinalysis changed management of patients with acute scrotal pain. Results: We identified 663 adult and pediatric patients who presented with scrotal pain during 2016. All patients had an ultrasound performed, and 458 (69.1%) had a urinalysis done. The sensitivity of urinalysis for epididymo-orchitis was 58.2% (95% CI 48.9% to 67.1%), and the specificity was 85.1% (95% CI 80.8% to 88.7%). For ultrasound, the sensitivity was 78.8% (95% CI 71.4% to 85.0%) and the specificity was 98.1% (95% CI 96.4% to 99.1%). In 24 of 458 cases (5.2% [95% CI 3.4% to 7.7%]) where a urinalysis was obtained, its results may have changed management of the patient. Conclusion: The diagnosis of patients who present to the ED with scrotal pain is primarily driven by the ultrasound results. While the urinalysis may occasionally provide some benefit in the evaluation of patients with suspected epididymo-orchitis, the reflexive ordering of a urinalysis in patients with scrotal pain may be unnecessary.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

<p>Assessing the Utility of Ultrasound and Urinalysis for Patients with Possible Epididymo-Orchitis – A Retrospective Study</p>

Zitek

Ahmed

Lim

et al. 2020

OAEM

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“…DUS compatible with TT reveals severe reduction or absence of testicular blood flow and signs of a twisted spermatic cord. Negative and Positive predictive values for evaluation of TT have been reported to be as high as 100% 11 . However, ultrasound is associated with high inter-examiner variability.…”

Section: Diagnostic Evaluationmentioning

confidence: 99%

“…In selected cases, in which TT is highy suspected, surgical exploration may be indicated without imaging studies, especially if the study will delay surgical exploration. Although scrotal scintigraphy and other tests have been used in the past, Doppler Ultrasonography of the Scrotum (DUS) is the most timely efficient exam available to date, with very good sensitivity and specificity 3 . In this review, we will outline key aspects in diagnostic work-up, specific features and treatment choices of the main conditions that may present as AS.…”

Section: Introductionmentioning

confidence: 99%

Acute scrotum: differential diagnosis and treatment

Barbosa

Arap

2018

Rev. Med. (São Paulo)

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Acute scrotum (AS) is a clinical syndrome characterized by scrotal pain of acute onset, often accompanied by scrotal swelling and other local and systemic signs and symptoms. It may be the initial presentation of several diseases including testicular torsion, orchitis, epididymitis, hydatid torsion, strangulated hernia and, less frequently, scrotal hematoma and testicular tumor. In the setting of emergency services, physicians should be extremely careful with the possibility of testicular torsion. This condition consists in the torsion of the spermatic cord, leading to an interruption of the testicular blood flow, with ischemia and ultimately necrosis. It is associated with acute severe pain, nausea, absence of the cremasteric reflex, and a high-riding testis. Physical examination may help diagnosis. However, a color Doppler ultrasound of the scrotum is usually required for a definitive diagnosis. Ultrasound will reveal a reduction or no blood flow to the affected testis; surgical treatment is mandatory and should be performed as early as possible. A differential diagnosis is orchiepididymitis. It may be of viral etiology in early childhood and bacterial after the beginning of sexual activity. The most specific sign associated with this condition is the relief of pain after elevation of the testis, known as Prehn’s sign. Treatment for bacterial cases requires antibiotics, while cases of viral etiology require only symptomatics. Hydatid torsion, including torsion of appendix testicularis and appendix epididymis may mimic testicular torsion but on ultrasound, blood flow is preserved, and a twisted appendix is often seen. Treatment for this condition consists only in symptomatic control. Testicular torsion should be treated as early as possible, since a delay of 6 hours may result in organ loss. Surgery consists of bilateral orchiopexy in case of a viable testicle and orchiectomy of a necrotic organ, always with fixation of the contralateral testicle.

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Groin and Testicle

Turial

2015

Diagnostic and Interventional Ultrasound in Pediatrics and Pediatric Surgery

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Role of ultrasound with color doppler in acute scrotum management

Cited by 23 publications

References 11 publications

<p>Assessing the Utility of Ultrasound and Urinalysis for Patients with Possible Epididymo-Orchitis – A Retrospective Study</p>

<p>Assessing the Utility of Ultrasound and Urinalysis for Patients with Possible Epididymo-Orchitis – A Retrospective Study</p>

Acute scrotum: differential diagnosis and treatment

Groin and Testicle

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