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


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: We compared color Doppler sonography and radionuclide imaging in an animal model of variable torsion of the testes. The testes of 19 rabbits with unilateral 0 degree (nontorsion), 180 degrees, 360 degrees, or 540 degrees torsion and contralateral nontorsion were evaluated by sonography serially over 24 hr. Color Doppler sonography and radionuclide imaging at 24 hr were compared and correlated with pathology in a subset of testes. Nontorsion (n = 16 testes) and 540 degrees torsion (n = 7 testes) were always correctly diagnosed at 24 hr by color Doppler sonography and radionuclide imaging. Torsion at 180 degrees (n = 2) was indistinguishable from nontorsion. With 360 degrees torsion (n = 6 testes), four testes had reduced or absent flow with color Doppler sonography, whereas only one testis was abnormal with radionuclide imaging. Nontorsion and extreme torsion of rabbit testes are well documented by radionuclide imaging and color Doppler sonography. Torsion at 360 degrees can result in variable flow alterations that are better detected by color Doppler sonography than by radionuclide imaging.
    No preview · Article · Dec 1995 · Academic Radiology
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    ABSTRACT: To compare power Doppler ultrasonography (US) with standard color Doppler US in the evaluation of testicular and epididymal blood flow in children. Testicular and epididymal flow were analyzed retrospectively in 24 testes in 12 prepubertal boys (mean age, 4 years) and 49 testes in 25 postpubertal boys (mean age, 14 years) with color and power Doppler US. Absence of testicular abnormality was based on clinical follow-up or scintigraphy. Power Doppler US depicted flow in 22 of 24 prepubertal testes and in all 49 postpubertal testes. Color Doppler US depicted flow in 20 prepubertal testes and in all 49 postpubertal testes. Flow was detected in five and three postpubertal epididymides with power and color Doppler US, respectively. A greater mean number of vessels per 1 cm2 of testicular parenchyma were detected with power than with color Doppler US in pre- and postpubertal testes. Power Doppler US improves depiction of intratesticular vessels, but flow cannot be identified in all prepubertal testes. Detection of epididymal flow is infrequent in postpubertal patients but appears comparable with both techniques.
    No preview · Article · Mar 1996 · Radiology
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    ABSTRACT: We performed this study to determine whether scrotal trauma can cause hyperemia of the epididymis. This diagnosis is helpful because traumatic epididymitis can be treated conservatively. We retrospectively reviewed color Doppler and gray-scale sonograms of five patients who had suffered trauma to the scrotum that resulted in epididymal hyperemia, which we called traumatic epididymitis. We also reviewed the presentation and management of each patient. Color Doppler sonography revealed focal (one patient) and diffuse (four patients) hyperemia. Gray-scale images revealed epididymal enlargement in all patients. These findings were indistinguishable from those of infectious epididymitis by sonography. One patient also had hyperemia of the testis. Four of the five patients were managed conservatively; the other underwent surgical exploration for a coexisting testicular rupture. Careful evaluation of the epididymis with both gray-scale and color Doppler sonography should be part of every sonographic survey of the scrotum for blunt trauma. Traumatic epididymitis, which may be noted on color Doppler images, should not be confused with infectious epididymitis. Surgery is not necessary unless another injury requires it.
    Preview · Article · Jul 1996 · American Journal of Roentgenology
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