Type:
Educational Exhibit
Keywords:
Emergency, Genital / Reproductive system male, CT, Ultrasound, Ultrasound-Colour Doppler, Contrast agent-intravenous, Acute
Authors:
C. aslanidi, S. Athanasiou, Z. Papoutsou, V. Mamalis, S. Mylona, A. Tsanis
DOI:
10.26044/ecr2023/C-20007
Findings and procedure details
Due to the high variability and low specificity of the symptoms of TVT, a high suspicion rate is required in order to accurately diagnose the condition. Doppler ultrasound is the gold standard imaging technique due to its high sensitivity and specificity while it can also be used to differentiate between other causes of ASP.
Ultrasound imaging findings include a non-compressible hypoechoic tubular structure located in the spermatic cord and possible extending within the pelvic cavity, with absence of flow in the Colour Doppler ultrasound
. Also, a negative Valsalva maneuver can help differentiate TVT from a varicocele.
Potential mimickers of TVT include testicular torsion
, epididymo-orchitis
, testicular trauma
, complicated hernia or spermatocele
. It is crucial to differentiate TVT from the above conditions, due to the different treatment course of each entity. In order to exclude other pathological conditions of the testicle, the radiologist should check the contour and echogenicity of the testes, the morphology, echogenicity and symmetry of the epididymis as well as the possible presence of solid or cystic lesions inside the scrotum.
Computed tomography (CT) may be necessary in order to evaluate the extent of the thrombosis and rule out potential compression of the testicular vein inside the abdomen by retroperitoneal masses.