Pictorial Review: Sonographic Findings of Scrotal Emergencies

Congress:

ECR 2020

Poster Number:

C-00382

Type:

Educational Exhibit

Keywords:

Not applicable, Trauma, Infection, Acute, Diagnostic procedure, Complications, Ultrasound-Colour Doppler, Ultrasound, Genital / Reproductive system male, Emergency, Anatomy, Genitourinary

Authors:

L. R. Rodriguez-Ortiz¹, X. E. Lopez Garib², A. Saldana¹, O. Concepcion³, W. Rodriguez-Mojica¹; ¹San Juan, PR/US, ²San Juan, Puerto Rico/US, ³Dorado, PR/US

DOI:

10.26044/ecr2020/C-00382

DOI-Link:

https://dx.doi.org/10.26044/ecr2020/C-00382

Fig. 1: Schematic Anatomy of the Scrotum.

Fig. 2: Basic Sonographic Anatomy of the Scrotum, Longitudinal View.

Fig. 4: Saddle View.

Fig. 9: Scrotal Wall Hematoma. (A) Longitudinal view of the left hemiscrotum shows an...

Fig. 16: Testicular Torsion. There is no evidence of blood flow to the right testicle...

Fig. 22: Severe acute epididymitis, causing vascular insult to the testicle. There is...

Learning objectives

Review the basic anatomy of the scrotum. Describe a stepwise approach for sonographic evaluation of the scrotum. Discuss and illustrate the key sonographic imaging findings of scrotal emergencies.

Background

The acute scrotum is defined as sudden intense scrotal pain with associated swelling and tenderness, in which systemic symptoms may be present including nausea, vomiting, and fever. The diagnostic etiologies leading to acute scrotum are vast, with considerations based on the patient’s age. Etiologies include testicular torsion, infectious processes, and scrotal trauma. Ultrasound (US) is the gold standard imaging modality for the evaluation of acute scrotal pain. The goal of early ultrasound evaluation is to rule out testicular injury, especially in young patients in which...

Findings and procedure details

Anatomy Review The scrotal sac is divided at midline by a septum, each half containing a testis and associated structures[2]. The scrotal sac has several layers that cannot be distinguished using USFig. 1.The tunica vaginalis is composed of two layers: the parietal layer lining the scrotal wall and the visceral layer lining the testicle and epididymis [1,2,7]. The space between the layers of the tunica vaginalis creates a potential space for fluid accumulation. The visceral layer of the tunica vaginalis adheres to the tunica albuginea,...

Conclusion

Ultrasound is a highly valuable imaging modality for the evaluation of scrotal emergencies. Differential diagnosis may be vast, with diagnostic considerations based on patient’s age. Scrotal traumatic injury, testicular torsion and infectious processes are important diagnosis every radiologist should recognize.

Personal information and conflict of interest

L. R. Rodriguez-Ortiz; San Juan, PR/US - nothing to disclose W. Rodriguez-Mojica; San Juan, PR/US - nothing to disclose X. E. Lopez Garib; San Juan, PUERTO RICO/US - nothing to disclose A. Saldana; San Juan, PR/US - nothing to disclose O. Concepcion; Dorado, PR/US - nothing to disclose

References

Dogra, V. S., Gottlieb, R. H., Oka, M., & Rubens, D. J. (2003). Sonography of the Scrotum1. Radiology, (227), 28–33. doi: 10.1148/radiol.2271001744 Avery, L. L., & Scheinfeld, M. H. (2013). Imaging of Penile and Scrotal Emergencies. RadioGraphics, 33(3), 721–740. doi: 10.1148/rg.333125158 Bandarkar, A. N., & Blask, A. R. (2018). Testicular torsion with preserved flow: key sonographic features and value-added approach to diagnosis. Pediatric Radiology, 48(5), 735–744. doi: 10.1007/s00247-018-4093-0 Bhatt, S., & Dogra, V. S. (2008). Role of US in Testicular and Scrotal Trauma. RadioGraphics, 28(6),...