Sonography of the Pediatric Scrotum: Emphasis on the Ts—Torsion, Trauma, and Tumors

Abstract

Many pediatric scrotal disorders can be well characterized on sonography. An understanding of the various disease entities, their clinical presentations, and the typical sonographic features should all be combined to make an accurate diagnosis.

Sonography of the acute scrotum in children

“…Testicular appendages are more frequent than epididymal appendages. Distinction is often difficult to make but it is not clinically important (15). Torsion of the appendix testicle occurs mainly in pre-pubertal boys (aged 6-12 years), is more frequent on the left side, and is a common cause of acute scrotum in this age group (1,16,17).…”

“…Primary isolated orchitis is less common than secondary epididymo-orchitis and is usually viral in origin. The clinical spectrum ranges from mild tenderness to a severe febrile process (3,15). Patients typically present with a gradual onset of scrotal pain with fever.…”

“…Testicular trauma is the third most-common cause of acute scrotal pain and may result in various degrees of damage to the testicles. Scrotal trauma in boys is most commonly due to sports-related activities (> 50%), followed by motor vehicle accidents (17%) (15,29). Ultrasonography is the first-line imaging for the assessment of scrotal trauma.…”

“…Ultrasonography usually shows avascular heterogeneous complex collections within or outside the testicle, corresponding to the hematoma (15,30,31). Treatment of small hematomas is usually conservative; however, large hematomas may require surgical intervention to evacuate hematoma and prevent pressure necrosis and testicular atrophy (30).…”

Imaging Techniques Used in the Diagnosis of Pediatric Tumors

“…It can show increased blood fl ow and disorganized vasculature in tumors such as in testicular lymphoma or primary gonadal germ cell tumors [ 12 ]. Doppler of hepatic hemangiomas typically shows both arterial and venous waveforms with minimal systolic-diastolic variation in contrast to primary liver malignancies that show high-velocity blood fl ow [ 7 ].…”