International Journal of Radiology and Diagnostic Imaging
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2024, Vol. 7, Issue 3, Part A

Ultrasound and color Doppler in assessment of acute scrotal lesions
Author(s)
Mohamed A El Barbary, Samir A El Gamal, Mohammed E Hegazy and Atef H Teima
Abstract
Background: The clinical features of acute scrotum are usually pain with or without scrotal swelling. In maximum cases, conservative or non-surgical approach can be followed but if there is spermatic cord torsion, immediate surgical intervention has to be done so that testis can be preserved.
Methods: This prospective study was conducted on 50 patients who were referred to our Department of Radiodiagnosis at Tanta university Hospitals presenting with acute scrotal pain between February 2021 and February 2022. Scrotal ultrasound was performed with a linear 7 to 12-MHz transducer with abundant acoustic gel. Imaging was done in longitudinal and transverse planes with Power Doppler and Color Doppler. The testes, epididymis, spermatic cord, scrotal wall and inguinal region were evaluated. Additional techniques such as the Valsalva maneuver or upright positioning was used for evaluating varicocele. Both testes were examined for size, echotexture and internal vascularity. B-mode parameters such as gain, depth, focus number and position as well as dynamic range were adjusted for better assessment. Both epidydmi were evaluated and compared to each other regarding size, echotexture and internal vascularity. Both spermatic cords were examined for thickness and vascularity as well as deep inguinal rings were examined in supine and erect position for exclusion of inguinal henria.
Results: All the 50 patients (100%) of our study were presented by scrotal pain, 18 patients (36%) presented by scrotal swelling while 14 patients (28%) presented by scrotal erythema. Only 6 cases (16.7%) with epididymo-orchitis, 4 cases (80%) with testicular torsion, 2 cases (100%) with incarcerated inguinal hernia, 6 cases (85.7%) with varicocele were presented with scrotal swelling, also erythema was presented in 13 cases with epididymo-orchitis and in only 1 case (20%) with testicular torsion.
Out of 50 patients of our study; 36 patients were diagnosed as epididymo-orchitis (72%), 7 patients as varicocele (14%), 5 patients as testicular torsion (10%) and only 2 patients as incarcerated inguinal hernia (4%).
Conclusion: In our study, from diagnostic point of view, whirlpool sign with absence of vascularity in distal spermatic cord and testis was the key finding for torsion cases. For epididymo-orchitis, increased vascularity in epididymis & testis were the indicative parameters. For incarcerated hernia, the diagnostic point was akinetic bowel loop in the inguino scrotal region with absent or minimal vascularity of that bowel loop.
For varicocele, dilated venous channels with reflux on Valsalva maneuver was considered. So, to conclude, ultrasound with color Doppler is very useful modality for diagnosing acute scrotum.
Pages: 19-26 | Views: 316 | Downloads: 170


International Journal of Radiology and Diagnostic Imaging
How to cite this article:
Mohamed A El Barbary, Samir A El Gamal, Mohammed E Hegazy, Atef H Teima. Ultrasound and color Doppler in assessment of acute scrotal lesions. Int J Radiol Diagn Imaging 2024;7(3):19-26. DOI: 10.33545/26644436.2024.v7.i3a.392
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