Role of Echo Doppler in Diagnosing the Testicular Torsion-Retrospective Study (original) (raw)
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Pakistan Armed Forces Medical Journal
Objective: To determine the diagnostic accuracy of ultrasound with Doppler analysis in testicular torsion, keeping surgical findings as the gold standard. Study Design: Cross-sectional validation study Place and Duration of study: Radiology Department of Pakistan Institute of Medical Sciences, from Dec 2017 to Dec 2019. Methodology: The study included 58 candidates of acute scrotum who were clinically equivocal with a strong suspicion of testicular torsion and were referred by the concerned surgery department to Radiology, where a senior resident performed the testicular ultrasound. The grey scale features, along with doppler findings, were noted. Only those cases that underwent surgical exploration were included. The clinical, sonological, and per-operative findings were recorded. Results: The mean age of our study was 18.00±6.02 years. The sensitivity, specificity, positive predictive value and negative predictive value of Doppler ultrasound were 98%, 86%, 98% and 86%, respectivel...
Critical validation of ultrasound Doppler in the diagnosis of torsion of undescended testis
The Israel Medical Association journal : IMAJ, 2007
Testicular torsion associated with undescended testis is uncommon but requires immediate treatment. Ultrasound Doppler is recognized as the preferred imaging modality for testicular torsion due to its high specificity, sensitivity and availability. To determine the accuracy of ultrasound Doppler in diagnosis of torsion of undescended testis. We describe three patients with known undescended testis who were admitted with groin pain and had preoperative ultrasound Doppler. The discrepancy between these and the intraoperative findings is discussed. In two patients incarcerated inguinal hernia was diagnosed with ultrasound Doppler; however, surgery revealed torsion of an undescended testis. In the third patient ultrasound Doppler diagnosed torsion of undescended testis, but at surgery incarcerated inguinal hernia was found, without evidence of testicular torsion. Torsion of undescended testis should be a clinical rather than radiologic diagnosis.
Torsion Testis : Role of Color Doppler : A Study of 50 Cases
Journal of Evidence Based Medicine and Healthcare, 2015
BACKGROUND: Torsion testis is one of the catastrophic conditions in children and young adults. Traditionally the diagnosis was made clinical presentation and suspicion. Critical decision making is essential to save the testis. OBJECTIVE: To study the usefulness and efficacy of Doppler ultrasound in correctly diagnosing acute scrotal conditions in children and young adults to save the testis and to avoid negative explorations. METHODS: Over a period of two years 50 patients with acute scrotum were admitted in general surgery department who underwent Doppler ultrasound scrotum and its efficacy in correctly diagnosing the pathology was analysed. RESULTS: 50 patients with age group <25 years were included in study. Scrotal pain was the most frequent presenting symptom of acute scrotum (98%) followed by Swelling of the hemiscrolum on the involved side present in 86% of the patients. Doppler ultrasound showed torsion of testis in 18 patients. On Scrotal exploration, torsion of spermatic cord was confirmed in 16 patients, one patient had torsion of appendix of testis and the other had Epididymo-orchitis. Thus the sensitivity and specificity of Doppler ultrasonography for testicular torsion was 86.9% and 92.6% respectively. 2 patients with equivocal Doppler findings, but strong clinical suspicion of testicular torsion were explored, and testis was found to be torsed in both two patients. Doppler ultrasonography showed Epididymo-orchitis in 22 patients, torsion of testicular appendage in 2 patients, Idiopathic scrotal edema in one, and in 5 pts no significant pathology found. All twenty patients of epididymo-orchitis, two patients of torsion of testicular appendage, and one patient of idiopathic scrotal edema were managed conservatively. At three weeks follow up, all the patients were free of symptoms. The sensitivity and specificity of Doppler ultrasonography for epididymo-orchitis was 95% and 100% respectively. CONCLUSIONS: color Doppler ultrasound is useful investigation in acute scrotum to confirm or to exclude torsion testis.
Clinical and Imaging Features of Testicular Torsion: Role of Ultrasound
Clinical Radiology, 1999
The early and accurate diagnosis of testicular torsion remains a clinical challenge. The implications of a missed diagnosis have emphasized the need for a non-invasive test for confirming testicular ischaemia; a problem highlighted by difficulties in establishing the diagnosis clinically. Understandably, the advent of colour Doppler ultrasound (CDUS) (and subsequently 'power' Doppler and microbubble ultrasound contrast), has been greeted with enthusiasm. However, as in other fields of medicine, a policy placing sole reliance on a single technique is likely to be flawed. This review will critically evaluate the role of CDUS and other imaging modalities in the diagnosis of testicular torsion. Sidhu, P. S. (1999) Clinical Radiology 54, 343-352.
Ultrasonographic diagnosis of testicular torsion by emergency physicians
The American Journal of Emergency Medicine, 2000
Testicular torsion has an incidence of one case per 4,000 men/boys. Most frequently affected are pubescent boys. Average testicular salvage rate is only 50%, and infertility can result. Testicular torsion remains problematic for emergency physicians (EPs) as clinical diagnosis can be difficult and other testicular pathology can present similarly. In many institutions there are delays in obtaining Doppler or Scintigraphy studies during off-hours. We report two cases of testicular torsion diagnosed by the treating EPs using power Doppler in the emergency department (ED). Rapid diagnosis of torsion led to successful salvage of the affected testicle in both cases. These represent the first cases for emergency screening ultrasound examinations (ESUEs) of testicular torsion in the literature. Rapid technological advances over the last decade have brought portable equipment with high.resolution capability to the bedside for EPs, who should consider using it more frequently to evaluate testicular torsion.
Correlation of ultrasonography and surgical outcome in patients with testicular torsion
Pan African Medical Journal
Introduction: testicular torsion is a surgical emergency that is caused by twisting of the spermatic cord and its content. This condition causes irreversible changes after 6 hours. Early recognition and management of testicular torsion is important for testicular salvage and preservation of fertility. Methods: this is a retrospective study done on all patients who presented with acute scrotal pain from January 2013 to December 2017. The data collected included the patient's age, symptoms, the time duration between the onset, ultrasound, and surgery, ultrasound findings with Doppler and the surgical intervention. Statistical analysis was performed using SPSS 25.0. Data are presented as mean (SD) values. Differences between groups and predictive values were calculated using Chi-square, t-test and Mann-Whitney U-test and are expressed by value with 95% CI. Results: the total number of patients who presented with acute scrotal pain were 88. Testicular torsion was diagnosed in 55 (62.50%) of the patients, 17 (19.32%) had epididymis-orchitis, 5 (5.68%) had torsion of appendage/cyst, and 11 (12.50%) had normal testis. Ultrasound has a sensitivity and specificity of 88.24% and 68.40% respectively. It is a good tool to detect testicular torsion but it is operator dependent. Positive predictive value was 83.33% and negative predictive value was 76.47%. When ultrasound is combined with clinical findings the rate of negative exploration is reduced by 10%. Conclusion: good medical history, appropriate clinical evaluation and performing an ultrasound of the scrotum are important in testicular torsion. US evaluation in cases presented after 24 hours does not change the outcome.
Decoding Acute Scrotum: Diagnostic Accuracy of Ultrasound in Urgent Clinical Settings
Cureus, 2024
Abstract Background Acute scrotum is a medical emergency commonly encountered in clinical practice, particularly in pediatric and adolescent populations. It is characterized by sudden onset of scrotal pain and may involve swelling, redness, or tenderness. The most common etiologies include testicular torsion, epididymo-orchitis, trauma, and, less frequently, tumors. Early and accurate diagnosis is critical, especially in cases of testicular torsion, where timely surgical intervention is required to preserve testicular viability. Ultrasound (US), particularly high-resolution gray-scale imaging combined with color Doppler (CD), has emerged as the primary imaging modality for evaluating acute scrotal conditions due to its accessibility, non-invasiveness, and high diagnostic accuracy. Aims and objectives This study aims to assess the diagnostic accuracy of US in differentiating the causes of acute scrotum, specifically focusing on testicular torsion, epididymo-orchitis, and varicocele. We also evaluate its role in reducing unnecessary surgical explorations and improving clinical decision-making in urgent settings. Materials and methods This retrospective observational study was conducted in a tertiary care center in Puducherry, India. A total of 250 male patients, ranging in age from 10 to 70 years, presented with acute scrotal pain over the 12-month study period. Inclusion criteria included all patients with sudden scrotal pain, regardless of clinical suspicion of underlying pathology. US scans were performed using a 7.5- to 12-MHz linear transducer. Gray-scale imaging was used to evaluate the testes, epididymis, spermatic cord, scrotal wall, and inguinal region, while CD was used to assess vascular flow. Statistical analysis was conducted using SPSS Version 18 (IBM Corp., Armonk, NY). Diagnostic accuracy was calculated based on sensitivity, specificity, positive predictive value, and negative predictive value. Results The most common cause of acute scrotum was inflammatory pathology, including epididymo-orchitis, accounting for 56.4% of cases (141 patients). Varicocele was the second most common cause, diagnosed in 11.6% of patients (29 cases), while hernias and epididymal cysts were found in 8% and 7.6% of cases, respectively. Testicular torsion was diagnosed in 2% of cases (five patients). US demonstrated high diagnostic accuracy for inflammatory pathologies, with sensitivity and specificity reaching 97% and 96%, respectively. The sensitivity for testicular torsion was 62%, reflecting the challenges in diagnosing partial or intermittent torsion, while specificity was high at 99%. US's performance in identifying varicocele was excellent, with a sensitivity of 93% and specificity of 98%. Conclusion US, especially when combined with CD, is an indispensable tool in the emergency evaluation of acute scrotum. It provides high diagnostic accuracy for inflammatory pathologies and varicocele while serving as an effective screening modality for testicular torsion. This study reinforces the role of US in reducing unnecessary surgical explorations, guiding clinical management, and improving patient outcomes in urgent clinical settings.
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.