Color flow imaging in children with clinically suspected testicular torsion.

Department of Radiology, Children's Hospital of Michigan, Detroit.
Pediatric Radiology (Impact Factor: 1.57). 02/1992; 22(5):370-3. DOI: 10.1007/BF02016260
Source: PubMed

ABSTRACT 32 boys with symptoms of an acute scrotum had testicular sonography with color flow imaging (CFI). Patients ranged in age from 4-15 years (avg = 11 yrs). Symptoms were present from 12 h to 5 days (avg = 42 hrs). CFI correctly predicted presence or absence of testicular perfusion in 11 boys who had surgical exploration of the scrotum. 8 of these 11 patients had hemorrhagic infarction of the testicle, 1 had torsion of the appendix epididymis, 1 had epididymitis, and 1 had bilateral incomplete torsions with normal testicular perfusion. The remaining 21 patients did not have an operation. At least a 1 year follow-up of all patients has shown no clinical evidence of testicular atrophy to suggest a missed diagnosis of torsion. Absence or markedly decreased testicular flow was easily identified and indicates testicular ischemia/infarction. Conversely, hyperemia of the testis and/or epididymis is usually associated with trauma or infection. However, incomplete torsion or spontaneous detorsion may demonstrate normal testicular flow on CFI. Only close correlation of clinical symptomatology and gray scale findings with CFI can identify these patients, who remain at high risk for subsequent complete torsion and infarction.

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    ABSTRACT: In this paper, we review the clinical and imaging features of the two most common causes of the acute scrotum, testicular torsion and epididymitis/orchitis. Pertinent anatomy, imaging study techniques and pitfalls in diagnosis are discussed.
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    ABSTRACT: To compare testicular color Doppler sonography with testicular scintigraphy in differentiating between surgical and nonsurgical conditions of the pediatric testis, and to evaluate the role of testicular color Doppler sonography in the pediatric population. Forty-six children (age range, 1 day to 18 years; median age, 11 years) with acute scrotal pain were evaluated with both scintigraphy and color Doppler sonography by two separate groups of radiologists who had no knowledge of the results of the other modality. The final radiologic diagnosis was classified as a surgical condition, nonsurgical condition, or indeterminate and was compared with the patient's surgical diagnosis or clinical diagnosis, which was established by response to treatment and follow-up. Sonography correctly diagnosed 11 of 14 surgical conditions and 31 of 32 nonsurgical conditions. There was one indeterminate sonogram. There were no false-positive examinations, and there were three false-negative examinations (sensitivity = 78.6% [95% CI, 66.7-90.5%], specificity = 96.9% [95% CI, 94.3-99.5%], accuracy = 91.3%). Color flow was demonstrated in the asymptomatic testis in 34 of 44 boys. Scintigraphy correctly diagnosed 11 of 14 surgical conditions and 29 of 32 nonsurgical conditions. There were two indeterminate scintigrams. There were two false-positive examinations and two false-negative examinations (sensitivity = 78.6% [95% CI, 66.7%-90.5%], specificity = 90.6% [95%CI, 82.2%-99.0%], accuracy = 87.0%). Color Doppler sonography and scintigraphy show similar sensitivity for the diagnosis of testicular torsion. A small number of false-negative cases can occur with either modality. The two studies may provide complementary information in indeterminate cases.
    Pediatric Emergency Care 05/2002; 18(2):67-71. · 0.89 Impact Factor