Testicular Torsion: Pitfalls of Color Doppler Sonography

Steinhardt, George F.; Boyarsky, Saul; Mackey, Richard A.

doi:10.1016/s0022-5347(17)35512-x

Cited by 78 publications

(26 citation statements)

References 8 publications

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“…In clinical practice, the above investigative techniques may, however, not be readily available. When available, they may be of limited reliability, especially in children [1,[4][5][6]. Surgical exploration remains crucial as an early exploration can save the testis from necrosis or atrophy.…”

Section: Resultsmentioning

confidence: 99%

The Etiology of Acute Scrotal Swelling on Surgical Exploration among Children and Adolescents in Jahra

Grover¹,

Adib²,

Joseph³

et al. 1998

Med Princ Pract

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Objective: To describe the clinical presentation as well as the outcome of surgically explored acute scrotal swellings among children and adolescents recorded at the Al-Jahra Hospital, Kuwait during the period 1985–1995. Methods: Hospital records of 120 cases were reviewed. Results: Seventeen percent of the cases were found to be testicular torsions (TT) and 40% torsions of testicular appendages (TAT). Other etiologies included traumatic swelling (15%), idiopathic edema (13%), epididymo-orchitis (10%), hydroele (4%) and others (2%). Ages of patients ranged from 6 months to 18 years, averaging 9.3 years (SD = 2.9) for TAT cases and 10.1 years (SD = 6.4) for TT cases. Swelling and pain were located on the left side for 65% of the torsion cases. Direct trauma was reported in 22% of the torsion cases. In 90% of TT cases, orchidopexy was performed with success. Subsequent testicular atrophy occurred in only 1 patient who had symptoms for more than 48 h prior to surgery. Orchidectomy was directly performed on necrosed testes in a patient with signs lasting more than 48 h, and another patient with signs lasting 4 days. Conclusions: Primary health care physicians in Jahra district should continue to educate parents and adolescents to recognize the gravity of scrotal pain, and the importance of early response as a way of avoiding testicular necrosis.

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Section: Resultsmentioning

confidence: 99%

The Etiology of Acute Scrotal Swelling on Surgical Exploration among Children and Adolescents in Jahra

Grover¹,

Adib²,

Joseph³

et al. 1998

Med Princ Pract

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“…However, the role of sonography has been under debate with respect to accuracy, availability, cost, delay in treatment, and as the procedure is operator-dependent [1,13,14] . In our experience, sonography was accurate in only 72.7% of patients with testicular torsion, where it was most critical to make the correct diagnosis.…”

Section: Discussionmentioning

confidence: 99%

The Acute Scrotum: A Review of 40 Cases

2005

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Objective: To determine the relative importance of clinical presentation, laboratory studies, and ultrasonography in the diagnosis of acute scrotum, and to suggest an effective method of management. Subjects and Methods: Forty patients who were hospitalized between January 2002 and December 2002 for acute scrotum were studied with respect to history, physical examination, blood tests, urine analysis including culture, and scrotal ultrasonography with color Doppler study. Results: Epididymitis (n = 24) was the commonest cause of acute scrotum followed by testicular torsion (n = 11), torsion of testicular appendages (n = 4), and idiopathic scrotal edema (n = 1). Both mean age (40.7 vs. 13.8 years), and average duration of pain at presentation (4.5 days vs. 19.1 h) were higher in patients with epididymitis than in torsion. Onset was usually insidious in epididymitis, sudden in testicular torsion, and variable in torsion of testicular appendages. The majority (87.5%) of patients with epididymitis were managed conservatively. The testis was salvaged in 81.8% of patients with testicular torsion. The accuracy of ultrasonography was only 72.7% in testicular torsion, but was good in epididymitis. Conclusion: Our results show that a careful clinical evaluation, by an experienced examiner, provides the correct diagnosis in acute scrotum rather than ultrasonography. It is of utmost importance to exclude testicular torsion in those who are younger than 16 years and whose pain duration is less than 24 h.

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“…12 Color flow Doppler ultrasound achieves up to an 86% sensitivity and 100% specificity in the diagnosis of testicular torsion; 13 however, others have questioned the accuracy of color Doppler flow sonography in the pediatric population. 14 To establish the diagnosis of torsion of the appendix testis with non-invasive imaging is more difficult. If color flow Doppler delineates a circular mass with an hypervascular echogenic rim surrounding a central hypoechoic region, situated near the superior pole of the testicle, this may indicate torsion of an appendix testis with adjacent reactive inflammation.…”

Section: Discussionmentioning

confidence: 99%

“…Torsion of the appendix testis occurs during the prepubertal years (ages [7][8][9][10][11][12][13][14], often precipitated by trauma or exercise. 1,2 We report the successful sonographic imaging and non-operative management of a case of metachronous torsion of the appendix testis.…”

Section: Introductionmentioning

confidence: 99%

Metachronous bilateral torsion of the testicular appendices

Monga

Scarpero²,

Ortenberg³

1999

Int J of Urology

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Background: Torsion of the appendix testis is a common cause of scrotal pain in children and a common cause for surgical exploration of the pediatric scrotum. The first case of metachronous bilateral torsion of the testicular appendices managed by a non-operative approach is reported. Methods/Results: A case report and a computer-assisted review of the literature are presented. Physical findings of a tender, mobile mass over the anterior surface of the testis characterize the presentation. Doppler findings of normal blood flow to the testes with increased flow to the adjacent appendix testis can be utilized as an adjunct to diagnosis. Ultrasonographic findings of a pedunculated mass with a central hypoechoic area at the superior aspect of the testis support the diagnosis. Accurate non-operative diagnosis of torsion of the appendix testis permits successful conservative management with non-steroidal anti-inflammatory agents. Conclusions: Improvements in ultrasonographic and Doppler imaging of torsion of the appendix testis have facilitated the diagnosis of this entity and decreased the need for surgical exploration of the scrotum.

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Testicular Torsion: Pitfalls of Color Doppler Sonography

Cited by 78 publications

References 8 publications

The Etiology of Acute Scrotal Swelling on Surgical Exploration among Children and Adolescents in Jahra

The Etiology of Acute Scrotal Swelling on Surgical Exploration among Children and Adolescents in Jahra

The Acute Scrotum: A Review of 40 Cases

Metachronous bilateral torsion of the testicular appendices

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