Details
Category: Volume 10 Issue 03 March 2022
Hits: 601

Title: High Frequency USG and Colour Doppler USG in Scrotal Swelling

Authors: Dr Kunal Singh, Dr Manish Jaiswal, Dr Sohini Shah

 DOI: https://dx.doi.org/10.18535/jmscr/v10i3.25

Abstract

Introduction

Acute scrotum is described as "acute onset of scrotal discomfort and swelling that necessitates emergency surgery or specialized medicinal care".[1] Scrotal swellings are most prevalents in both children and adults.

Acute scrotum can be caused by a multitude of factors. Torsion of the testis, torsion of the appendix testis, epididymo-orchitis, scrotal wall abscess, Fournier's gangrene, scrotal haematoma, testicular tumor, and a variety of other diseases such as "idiopathic scrotal oedema, scrotal fat necrosis, Henoch Schonlein purpura, ischemic orchitis, Because of their incidence and severity, testicular torsion, epididymo-orchitis, and Fournier's gangrene need special attention.

Both testes are located on the surface of the scrotum in a cutaneous bag. Though it is easily accessible for clinical examination, it is difficult to distinguish benign from malignant swellings, as well as intra-testicular from extratesticular swellings, and hydrocele complicates determining the status of the underlying testis.

Clinical indications and symptoms are frequently ambiguous, changeable, and deceptive. As a result, visualizing is extremely useful for problem solving. Clinical assessment of scrotal contents was limited to palpation and trans-illumination until the mid-1970s.

Since Murray Miskin and Jerald Bain published their first report in 1974 on using diagnostic ultrasound to investigate scrotal pathologies, advances in instrumentation and transducer design have progressed to the point where high frequency US is now the modality of choice for investigating scrotal and testicular pathology.[2]

References

  1. William C S.Acute scrotal pathology. Surg C l N America 1982; 62 (6) : 955-970.
  2. Miskin M and Bain J: B-mode ultrasonic examination of the testes. Journal of Clinical Ultrasound, 1974 Dec; 2(4):307-11.
  3. Dogra VS, Gottlieb RH, Oka M, Rubens DJ. Sonography of the scrotum. Radiology 2003; 227: 18–36.
  4. Thomas RD, Dewbury KC. Ultrasound appearances of the rete testis. Clin Radiol. 1993;47:121–124. 
  5. Dogra VS, Gottlieb RH, Oka M, Rubens DJ. Sonography of the scrotum.  2003;227:18–36. 
  6. Horstman WG, Middleton WD, Melson GL, Siegel BA. Color Doppler US of the scrotum. 1991;11:941–957. 
  7. Burks DD, Markey BJ, Burkhard TK, Balsara ZN, Haluszka MM, Canning DA. Suspected testicular torsion and ischemia: evaluation with color Doppler sonography.  1990;175:815–821. 
  8. Middleton WD, Siegel BA, Melson GL, Yates CK, Andriole GL. Acute scrotal disorders: prospective comparison of color Doppler US and testicular scintigraphy. 1990;177:177–181. 
  9. Luker GD, Siegel MJ. Color Doppler sonography of the scrotum in children. AJR Am J Roentgenol. 1994;163:649–655. 
  10. Caesar RE, Kaplan GW. Incidence of the bell-clapper deformity in an autopsy series. 1994;44:114–116.    
  11. Middleton WD, Middleton MA, Dierks M, Keetch D, Dierks S. Sonographic prediction of viability in testicular torsion: preliminary observations. J Ultrasound Med. 1997;16:23–27.
  12. Eaton SH, Cendron MA, Estrada CR, Bauer SB, Borer JG, Cilento BG, et al. Intermittent testicular torsion: diagnostic features and management outcomes. J Urol. 2005;174(4 Pt 2):1532–1535. 
  13. Chan PT, Schlegel PN. Inflammatory conditions of the male excurrent ductal system. Part II. J Androl. 2002;23:461–469. 
  14. Buckley JC, McAninch JW. Use of ultrasonography for the diagnosis of testicular injuries in blunt scrotal trauma. J Urol. 2006;175:175–178. 
  15. Cohen HL, Shapiro ML, Haller JO, Glassberg K. Sonography of intrascrotal hematomas simulating testicular rupture in adolescents. Pediatr Radiol. 1992;22:296–297. 
  16. Cass AS, Luxenberg M. Testicular injuries. 1991;37:528–530. 
  17. Bhandary P, Abbitt PL, Watson L. Ultrasound diagnosis of traumatic testicular rupture. J Clin Ultrasound.  1992;20:346–348. 
  18. Gooding GA, Leonhardt W, Stein R. Testicular cysts: US findings.1987;163:537–538. 
  19. Dogra VS, Gottlieb RH, Rubens DJ, Oka M, Di Sant Agnese AP. Testicular epidermoid cysts: sonographic features with histopathologic correlation. J Clin Ultrasound. 2001;29:192–196. ]
  20. Langer JE, Ramchandani P, Siegelman ES, Banner MP. Epidermoid cysts of the testicle: sonographic and MR imaging features.  AJR Am J Roentgenol. 1999;173:1295–1299. 
  21. Woodward PJ, Schwab CM, Sesterhenn IA. From the archives of the AFIP: extratesticular scrotal masses: radiologic-pathologic correlation.   2003;23:215–240. 
  22. Fu YT, Wang HH, Yang TH, Chang SY, Ma CP. Epidermoid cysts of the testis: diagnosis by ultrasonography and magnetic resonance imaging resulting in organ-preserving surgery. Br J Urol. 1996;78:116–118. 
  23. Moghe PK, Brady AP. Ultrasound of testicular epidermoid cysts. Br J Radiol. 1999;72:942–945.
  24. Eisenmenger M, Lang S, Donner G, Kratzik C, Marberger M. Epidermoid cysts of the testis: organ-preserving surgery following diagnosis by ultrasonography. Br J Urol. 1993;72:955–957.
  25. Hricak H, Filly RA. Sonography of the scrotum. Invest Radiol. 1983;18:112–121.
  26. Rifkin MD, Kurtz AB, Goldberg BB. Epididymis examined by ultrasound. Correlation with pathology.  1984;151:187–19
  27. Jarvis LJ, Dubbins PA. Changes in the epididymis after vasectomy: sonographic findings. AJR Am J Roentgenol. 1989;152:531–534. 
  28. Holden A, List A. Extratesticular lesions: a radiological and pathological correlation. Australas Radiol. 1994;38:99–105.
  29. Reddy NM, Gerscovich EO, Jain KA, Le-Petross HT, Brock JM. Vasectomy-related changes on sonographic examination of the scrotum. J Clin Ultrasound.  2004;32:394–398. 
  30. Frates MC, Benson CB, Stober SL. Mobile echogenicities on scrotal sonography: is the finding associated with vasectomy? J Ultrasound Med. 2011;30:1387–1390. 
  31. Meacham RB, Townsend RR, Rademacher D, Drose JA. The incidence of varicoceles in the general population when evaluated by physical examination, gray scale sonography and color Doppler sonography. J Urol. 1994;151:1535–1538.
  32. Black JA, Patel A. Sonography of the abnormal extratesticular space. AJR Am J Roentgenol. 1996;167:507–511. 
  33. Rudloff U, Holmes RJ, Prem JT, Faust GR, Moldwin R, Siegel D. Mesoaortic compression of the left renal vein (nutcracker syndrome): case reports and review of the literature. Ann Vasc Surg. 2006;20:120–129.
  34. Micallef M, Torreggiani WC, Hurley M, Dinsmore WW, Hogan B. The ultrasound investigation of scrotal swelling. Int J STD AIDS. 2000;11:297–302. 
  35. Collings C, Cronan JJ, Grusmark J. Diffuse echoes within a simple hydrocele: an imaging caveat. J Ultrasound Med. 1994;13:439–442.
  36. Gooding GA, Leonhardt WC, Marshall G, Seltzer MA, Presti JC., Jr Cholesterol crystals in hydroceles: sonographic detection and possible significance. AJR Am J Roentgenol. 1997;169:527–529.

Corresponding Author

Dr Kunal Singh

Post graduate trainee, Department of Radiodiagnosis, Katihar Medical College, Katihar