1. To review the various pathologies that present as acute scrotal pain in the emergency department. 2. To emphasize the role of ultrasound (US) in the differential diagnosis of acute scrotum. 3. To describe the US findings in the most common conditions of acute scrotal pain, including contrast enhanced US (CEUS).

Introduction Acute scrotal pain in adults is a common urological emergency requiring fast diagnosis and treatment. Although the majority of patients with acute scrotal pain are usually young adults, any age group can be affected. The right diagnosis is crucial and leads to the decision of a conservative or surgical treatment. Acute scrotum is a challenging clinical problem. Correct diagnosis is crucial to determine appropriate treatment. Anatomy The anatomic structures that may be involved in the pathology of scrotum are the testis, tunica vaginalis, epididymis,...

US has an important role in the diagnosis of acute scrotum in the emergency department. Scrotal US is performed with the patient lying in a supine position. A 6-15 MHz high-frequency linear-array transducer is used. The testes are evaluated in longitudinal and transverse planes. It is always important to compare the size and echogenicity of each testis and epididymis. In patients being evaluated for an acute scrotum, the asymptomatic side should be examined primarily in order to set the gray-scale and color Doppler gain settings...

In the context of urgency, Doppler US is the imaging study of choice. In case of equivocal US findings, the use of CEUS is recommended, providing a more definitive diagnosis and avoiding the need for further investigation with other imaging studies. Specifically CEUS could be recommended in cases such as infarction and trauma, for the confirmation of testicular torsion as well as for the identification of a testicular mass. The diagnosis given by the Radiologist in a patient with acute scrotal pain plays a significant...

Kalliopi Melaki Radiologydepartment Evangelismos Hospital Athens,Greece Email:[email protected]

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