Ultrasound imaging of the “on call” acute scrotum

Abstract

Causes of the acute scrotum 1. Vascular -Spermatic cord torsion -Torsion of the appendix testis 2. Trauma -Testicular rupture/fracture -Haematoma/haematocele -Penetrating injury 3. Infective/Inflammatory -Epididymitis/epididymo-orchitis -Testicular abscess -Fournier's gangrene 4. Miscellaneous -Acute idiopathic scrotal oedema -Inguinoscrotal hernia -Testicular tumours -Henoch-Schonlein purpura Torsion of the spermatic cord-Is a surgical emergency-irreversible ischaemia occurs after 6 h -Represents 17% of all acute scrotal presentations, the incidence is 1 in 4000 males -Intravaginal torsion is associated with the bell-clapper deformity. Presentation is most commonly between the ages of 12-18 years -Extravaginal torsion is rare and occurs in utero or the perinatal period, the testis is usually unsalvageable -Greyscale ultrasound may be normal in immediate post-torsion period. Following this, sonographic changes frequently mimic acute epididymo-orchitis. -Lack of flow or diminished flow on colour/power Doppler implies torsion.Incomplete torsion will demonstrate a high resistance arterial waveform on spectral Doppler imaging Testicular trauma -The peak age range is 15-40 years -Blunt trauma secondary to sporting injury is the commonest cause -The main purpose of ultrasound examination in blunt trauma is to assess the integrity of the tunica albuginea and perfusion of the testicular parenchyma -Testicular rupture requires urgent surgical exploration to preserve normal endocrine function; surgery may also be required for large haematomas that are compressing the testis