The Testicles: Trauma, Inflammation and Testicular Torsion
The majority of cases of acute scrotum are due to one of these three causes: trauma, torsion and inflammation.
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Stefano Bucci, Michele Rizzo, Giovanni Liguori, Paolo Umari, Giovanni Chiriacò, and Michele Bertolotto
41.1 Introduction
41.2 P ractical Considerations in the Colour Doppler The majority of cases of acute scrotum are due to and Ultrasonography one of these three causes: trauma, torsion and Evaluation of the Scrotum inflammation. Acute scrotum syndrome of any origin always merits immediate evaluation to prevent testicular function and chronic irreversible complication [1]. Correct differential diagnoses between these conditions are mandatory because uncorrected diagnosis could lead to catastrophic consequence. Often physical examination is not sufficient to avoid suspicious conditions that require surgical correction and then imaging. High-resolution ultrasound is the imaging modality of choice for the examination of superficially located scrotal sac and its contents. Greyscale ultrasonography in combination with colour or power Doppler imaging is a well- accepted technique for assessing scrotal lesions and testicular perfusion. In this chapter, clinical features, greyscale and colour Doppler US appearance of testicular torsion, trauma and inflammation are described.
S. Bucci (*) • M. Rizzo • G. Liguori • P. Umari Department of Urology, University of Trieste, Trieste, Italy e-mail: [email protected] G. Chiriacò • M. Bertolotto Department of Radiology, University of Trieste, Trieste, Italy
At the beginning of this discussion, we should remember that colour Doppler ultrasound is a highly operator-dependent examination. In the clinical dilemma of the acute scrotal pain setting, the colour Doppler ultrasound is the primary imaging modality used. The examination should be preferably done with a broadband high-frequency linear transducer (ideally up to 10 MHz). It is a best practice, to begin the exam, analysing the asymptomatic side first in order to familiarise the patient with the procedure and to obtain an impression of the normal appearances of the testis. The comparison of the symptomatic side with the contralateral asymptomatic side is essential to exclude technical reasons as the cause of absent flow and to allow the diagnosis of unilateral increased flow to be made [2]. Increased flow diagnosis is achieved by including both testes on the screen at the same time, with the Doppler box covering part of each of the testis in cross section. To optimise detection of low velocity flow, the pulse repetition frequency (PRF) and filtration must be set low and a small colour sampling box should be used.
© Springer International Publishing Switzerland 2017 P. Martino, A.B. Galosi (eds.), Atlas of Ultrasonography in Urology, Andrology, and Nephrology, DOI 10.1007/978-3-319-40782-1_41
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We suggest to increase the gain until noise is seen and then slightly reduce it [3]. According to Lin, to optimise focal zone analysis, the sample volume of box flow should be inferior of the vessel lumen [4].
41.3 Testicular Torsion Testicular torsion is the rotation of the testis along its longitudinal axis. During test
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