Role of color Doppler ultrasonography in evaluation of scrotal swellings: pattern of disease in 120 patients with review of literature (original) (raw)
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Evaluation of Scrotal Pathology by High Resolution Ultrasound and Colour Doppler
Journal of Evolution of Medical and Dental Sciences, 2017
Clinical diagnosis of a scrotal swelling is not straightforward. It is often difficult to decide whether a palpable scrotal m ass is intratesticular or extratesticular. Moreover, the clinical examination may over look significant pathology and physical signs elicited may be improperly interpreted. The sonogram with high frequency linear transducer and colour Doppler is invaluable in evaluating scrotum and its contents. Sonography is simple to perform, rapid, non-invasive, relatively inexpensive, easily reproducible, widely available and does not expose the gonads to radiation. Aim and Objective-To evaluate various scrotal pathologies using ultrasonography and to describe the role of high resolution ultrasound and colour Doppler in their diagnosis. Fifty patients were descriptive studied over a period of 8 months from July '16 -Feb '17 using high-frequency real time gray scale ultrasonography and colour Doppler in our institution. Out of total 50 cases non-inflammatory pathologies were seen in 26 cases (52%), whereas inflammatory pathologies in 20 cases (40%). Among the inflammatory scrotal diseases, incidences of various pathologies were acute epididymo-orchitis-8 cases (40% of inflammatory category), chronic epididymo-orchitis-4 cases (20%), acute and chronic epididymitis-2 (10%) cases each. Among non-inflammatory pathologies, incidences of various pathologies were: hydrocele-in 23 cases (46% of total); epididymal cyst in 3 cases; varicocele, torsion, tumour, inguinal hernia and traumatic epididymitis-1 case each (3.84%). High frequency ultrasonography is highly sensitive in differentiating solid from cystic scrotal masses. Colour Doppler sonography is highly sensitive in diagnosing acute scrotal pathology, differentiating testicular torsion from acute inflammatory diseases and in demonstrating sub-clinical cases of varicocele.
Evaluation of Scrotal Lesions by Gray Scale Ultrasonography and Colour Doppler
Journal of Evolution of Medical and Dental Sciences, 2016
BACKGROUND Until the mid 1970's, scrotal examination was limited to palpation and transillumination. Miskin and Bain (1974) first reported the use of Ultrasonography to examine testes and scrotum. With advancement like colour Doppler, ability to assess testicular vascularity increased. Although other radiological investigations have roles in specific situations, present study was undertaken to evaluate the usefulness and accuracy of sonography and colour Doppler in scrotal abnormalities. METHODS The study was conducted in the Department of Radiodiagnosis, Max Super Speciality Hospital, Saket, New Delhi, between May 2012 and May 2013. Prospective study carried out in 100 patients after proper informed and written consent with inclusion criteria of 'All age patients with clinical suspicion of scrotal pathology' and exclusion criteria of 'History of operative or therapeutic procedures on the scrotum with exception of vasectomy.' These patients' scrotums were scanned in various plan on "Voluson 730 PRO" (GE Healthcare) system and LOGIC E-9 (GE Healthcare) using linear probe (As applicable) with comparison from asymptomatic side. Relevant other radiological and pathological investigations were done wherever indicated. RESULTS Majority of patients were between 21-40 years of age (62%) with commonest presenting complaint was scrotal swelling in 73%. Fluid collections were the commonest abnormality detected on sonography. Hydrocele was the most frequent fluid collection seen in 38 cases (26.3%). In acute inflammation, hypoechogenicity of the testes was most common sonographic feature. In our study, ultrasound showed 99% accuracy to distinguish between Intratesticular and Extratesticular pathology. CONCLUSIONS High-resolution USG with colour Doppler can reliably define the morphological features and vascularity of scrotal lesions. USG is highly accurate in evaluating the consistency of scrotal mass and in localizing scrotal abnormality. Ultrasound evaluation of the scrotum must include colour Doppler imaging of testis and epididymis with comparison from the asymptomatic side.
Evaluation of scrotal diseases with high frequency ultrasonography and colour Doppler sonography
Introduction:Ultrasonography (USG) has been established as an essential imaging modality in diagnosing scrotal pathology. This study aimed at assessing the utility of evaluating scrotal diseases with high frequency ultrasonography and color Doppler sonography.. This study was carried on all consecutive patients referred for scrotal gray scale ultrasonography and/or colour Doppler ultrasonography with scrotal pain or swelling of any duration. The patients underwent gray-scale and colour Doppler ultrasonography of the scrotum in the same sitting with a linear array colour Doppler multi-frequency (7 to 10 MHz) transducer using GE LOGIQ P5 ultrasound scanner. The findings were recorded on a predesigned proforma. Testicular size, blood flow, echogenicity and lesions were noted. Data was tabulated as frequency distribution tables. Results: During the study period 63 patients were included in the study. Acute epididymo-orchitis was the commonest inflammatory pathology noted in 15 cases, followed by scrotal wall inflammation &funiculitis in four cases each. Other cases of inflammatory scrotal pathology were acute epididymitis, acute orchitis, acute on chronic epididymo-orchitis, Fournier's gangrene and chronic epididymitis.High frequency and color Doppler sonography was accurate in each of these cases in determining the extratesticular or intratesticular origin of these conditions and in further characterisation of these conditions as per their number, vascularity and other sonographic characteristics. Conclusions: High frequency gray scale sonography andColor Doppler ultrasonography in combination is a reliable technique for evaluation of scrotal pathologies and helpful in guiding further management.
Acta Radiologica, 2020
Background Scrotal swellings have a non-specific clinical picture, so their clinical diagnosis is challenging. Scrotal grayscale and color Doppler ultrasound are non-invasive methods used in both adult and childhood groups and act as accurate screening and diagnostic modalities. Purpose To evaluate the diagnostic validity of grayscale and color Doppler ultrasound in the assessment of scrotal swelling to reach accurate diagnosis. Material and Methods A retrospective study included 181 patients (mean age = 35.5 ± 7.3, age range = 1–71 years) with scrotal swelling. Examinations were performed by an experienced radiologist using grayscale and color Doppler ultrasound. The diagnostic validity of grayscale and color Doppler ultrasound for diagnosing scrotal swelling were estimated using surgical findings, histopathological results, and imaging and clinical follow-up as reference standards. Results Overall, 202 scrotal swellings were detected. The final diagnoses were 13 (6.4%) malignant a...
High frequency & color doppler ultrasound evaluation of scrotal and testicular pathologies
2014
Introduction: The superficial location of the scrotal contents makes them ideally suited for sonographic examination. The development of high-frequency, real-time scanners along with color Doppler have enhanced the diagnostic accuracy of scrotal sonographic examinations. Sonography played a vital role in the evaluation of testes obscured from palpation by large hydrocele and accurately separated intra testicular from extra testicular masses, even when the location is equivocal on physical examination. Materials & Methods: A prospective study of 108 patients who presented with complaints of scrotal pathology. Gray scale sonography and color Doppler examination was carried out with linear array high frequency (6-7-9 MHz) for evaluation of patients. During ultrasound scan, on a routine basis patient history, clinical examination were evaluated. Observations were collected in a prescribed Performa for analysis. Results: Out of 108 cases, 19 had pathologies bilaterally and 89 had unilate...
Does color Doppler sonography improve the clinical assessment of patients with acute scrotum?
European Journal of Radiology, 2006
Introduction and objectives: Our experience concerning the use of color Doppler sonography (CDS) in the differential diagnosis of acute scrotum is reported. Material and methods: From July 2000 to July 2005, 155 patients (median 17.2 years) were admitted with a diagnosis of acute scrotum (unilateral in 150 cases, bilateral in 5). Along with a careful anamnesis and the physical exam, all patients underwent a CDS study of the scrotal content using a sonograph GE Logiq 500 with a multifrequency (7.5-10 MHz) linear probe Small Part. The following CDS parameters were evaluated: intensity of the color-power signal on the testicular parenchyma and on the epididymis; systolic peak velocity (SPV) and telediastolic velocity (TDV) in correspondence of the gonadal hilum. Ultrasound and flowmetry parameters registered on the painful testis were compared with those registered on the healthy controlateral testis. The reduction/absence versus the increase of color-power signal in the parenchyma and the reduction/absence versus the increase of SPV and TDV in the centripetal intratesticular arteries were considered presumptive of testicular torsion versus orchiepididymitis. Results: The results only refer to the 150 patients (300 testis) with acute monolateral scrotum. The clinical picture and the physical exam suggested a torsion of the spermatic cord in 40 cases, a spontaneous de-torsion in 5, an orchiepididymitis in 80, a blunt scrotal trauma in 15, a bulky epididymal cyst or a hydrocele in 4 and a testicular pain of unknown etiology in the remaining 6 cases. Standard US was pathological in 95 patients (63.3%); CDS was pathologic in 70 patients and in 42 of them suggested a testicular torsion. Fifty-three patients underwent surgical exploration: among 42 patients with a presumptive diagnosis of testicular torsion, the diagnosis was confirmed in 22 cases, no anomaly was found in 16 cases and in 4 patients a torsion of testicular appendix was found. The rupture of the tunica albuginea was present in six out of seven patients submitted to surgical exploration for previous blunt trauma and the sonographic diagnosis of hematocele was documented in all cases. The single false-negative diagnosis of testicular torsion in CDS occurred in an 18-month-old child. In presence of funicular torsion, the sensitivity and specificity of physical exam and CDS were 100% versus 95.7% and 86.5% versus 85.3%, respectively; sensitivity and specificity of SPV, TDV and color-Doppler signal on the testis were 100% and 94.8% versus 100% and 90.1% versus 95.7% and 90.8%. In the pre-operative assessment of scrotal trauma, the B-mode US showed a sensitivity and specificity of 100% and 90%, respectively; the color Doppler analysis has not supplied with additional elements for planning a surgical exploration. In presence of orchiepididymitis, the sensitivity and specificity of the physical exam in association to CDS was equal to 100%. In all patients with torsion of the testicular appendix, physical exam and CDS parameters were within normal limits. Discussion and conclusions: In our experience CDS is an indispensable imaging modality for the clinical assessment of patients with acute scrotum; however, the informations it can afford are operator-dependent and have to be supported by the history and physical exam of the patient. CDS findings constitute probably an important medico-legal support when the necessity of surgical exploration is excluded; anyway, in presence of a clinical suspicion of testicular torsion, even with an apparently normal CDS, the surgical exploration is recommended.
BACKGROUND & OBJECTIVE: There is a wide range of spectrum of pathologies which affects scrotum. Ultrasonography (US) findings help narrow the differential to benign or malignant causes. The purpose of our study is to evaluate different non traumatic scrotal pathologies in complain of pain and swelling in scrotum and to describe role of USG as a primary investigation of choice for different scrotal pathologies. METHOD: This paper reviews the incidence of different scrotal pathologies in total 46 patients presenting with complain of pain/swelling or both in scrotum for USG in Radiology Department of S.S.G. Hospital & Medical College Baroda in a period of 18 weeks study. RESULTS: Largest number of patients in this study, fall in the age group of 21-40 years and patients with exclusive testicular pathologies were 10 in number (i.e 21.7%) of all cases, out of which most common pathology was orchitis, while extra testicular scrotal pathologies were observed in 21 cases (i.e.45%) and majority of them were hydrocele. The most common cause of pain and swelling in scrotum was due to the epididymo-orchitis. CONCLUSION: USG is primary, non-invasive diagnostic technique without any radiation hazard, which is easily available and effective and can be an investigation of choice for different scrotal pathologies.
Frequency of Different Ultrasonographic Patterns in Patients Presenting with Acute Scrotum
2018
Background: Acute scrotum is sudden onset of swelling and pain in the scrotum or its contents, accompanied by local signs or general symptoms and is commonly due to testicular torsion, epididymitis, orchitis or epididymo-orchitis. The difficulty arises due to the similarities between the presentations. It is important to recognize sonograpic patterns of acute scrotum to reduce the need of exploratory surgery. Objective: To determine the frequency of different ultrasonographic patterns in patients presenting with acute scrotum. Methods: A cross-sectional study was conducted at Dow Institute of Radiology, Dow University of Health Sciences from 20 th April 2016 till 20 th October 2016. Male patients aged 16-45 years presenting with acute scrotum within 24 hours underwent scrotal ultrasound with color doppler imaging. Comparative axial and sagittal views of each scrotum were obtained. Images were interpreted by two radiologists in terms of echotexture, echogenicity, size of testes, hydr...
Ultrasonography Diagnosis of Scrotal Pathologies
Background and Objective: Ii is often difficult to diagnose the pathologies of testicle itself or adjacent parts in scrotum clinically. The aims of this study were to detect the abnormalities findings by use of ultrasound (u/s). Methods: Seventy five patients, with age ranging from 0 to ˃60 years(mean age of 35 +/- 5years), symptomatic with different scrotal clinical indications or infertility were examined by real-time ultrasound during the period fromOctober 2010 to February 2011 in King Abdulaziz University Hospital (KAUH)-Saudi Arabia, Jeddah. Results: Study showed that the commonest sonographic findings of scrotal were the varicocele was noted in 37.33% . Conclusion: Ultrasonography was the best imaging modality to diagnose many diseases of the scrotum. KEYWORDS: ultrasound, scrotal, testicle, scrotum, varicocele.
Evaluated of Testicular Tumors using Doppler Sonography
IOSR Journal of Dental and Medical Sciences, 2014
This study aimed to determine the gray scale and color Doppler sonographic features of the most common and some of the least common scrotal lesions. Between October 2012 to May 2013, 100 patients the age range of new born to 85 years old the mean 30.95, with scrotal symptoms, who underwent scrotal ultrasonography (US), were retrospectively reviewed. The clinical presentation, outcome, and US results were analyzed. The presentation symptoms including scrotal pain, painless scrotal mass or swelling, and trauma. Sonographic features that were reviewed included the size and echogenicity of the tumors, presence of cystic areas or calcifications,and distribution pattern of detectable blood flow on color or power Doppler imaging..This study revealed that of 100 patients the age range of new born to 85 years old the mean 30.95 (7%) presented with Testicular torsion , (10%) with epididymitis, epididymo-orchitis (13%), abscess (5%) ,encysted hydrocele (8%), varicocele (10%), Spermatocele ( 5%) , testicular malignancy (13%), orchitis (4%), hematoma 8 (8%), Scrotal hemia 6 (6%), undecended testis 8 (8%) and lymphoma (3%). Operation (orchiodectomy) was done for 6 pateint (one for testicular torsion ,second one inguinal hernia and undecended testis, ,two of seminoma and one unsenimotous disease). Color Doppler ultrasonography accurately diagnosed all cases of epididymitis or epididymo-orchitis, spermatic cord injury, testicular torsion, varicocele, and hydrocele .US provides excellent anatomic detail, The study concluded that Color Doppler ultrasonography is an excellent, a safe, and reliable method for evaluating patients with scrotal diseases. It aids in diagnosis of testicular tumors and reduces the number of unnecessary exploratory operations. It is especially important in conditions like testicular torsion where immediate diagnosis is required.