To identify the usual ultrasound imaging findings of the most frequent causes of acute scrotal pain.
To perform a proper differential diagnosis in order to establish an optimal therapeutic approach.
“Acute scrotal pain” may have many causes,
some of which require timely treatment in order to maintain fertility and hormonal activity.
Because of this time factor,
prompt imaging workup and rapid recognition of pathologic conditions are essential for an appropriate intervention.
Infectious conditions include epididymitis,
and Fournier gangrene.
Ischemic events may occur in the setting of testicular torsion.
Trauma is the third most common cause of acute scrotal pain.
Testicular tumors usually manifest as a painless scrotal mass.
Findings and procedure details
Ultrasonography (US) is the modality of choice for the initial evaluation of these patients,
because it provides excellent anatomic detail without subjecting the gametes to ionising radiation; by using color Doppler and power Doppler imaging,
testicular perfusion can be assessed.The most important aim of imaging in these patients is to rule in or out testicular torsion,
which requires immediate intervention ( Fig. 1 ).
Scanning is performed with a high-frequency (8–15 MHz) transducer in sequential sagittal and transverse planes.
Acute scrotal pain may have many causes,
some of which are acute medical or surgical emergencies.
Clinical manifestations are common to these entities and are not always indicative. A correct US-based differential diagnosis allows medical staff to focus on directing the patient to the most appropriate treatment.
Mariangela Di Marco,
Imaging of Penile and Scrotal Emergencies.
RadioGraphics 2013; 33:721–740
Role of US in Testicular and Scrotal Trauma.
Radiographics 2008; 28:1617-1629.
Gray-Scale and Color Doppler Sonography of Scrotal Disorders in Children: An Update.
RadioGraphics 2005; 25:1197–1214.
US of Acute Scrotal Trauma: Optimal Technique,