Acute testicular torsion in children: the role of sonography in the diagnostic workup |
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Authors: | P Gunther JP Schenk R Wunsch S Holland-Cunz U Kessler J Troger KL Waag |
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Institution: | (1) University of Heidelberg, Department of Paediatric Surgery, Im Neuenheimer Feld 110, 69120 Heidelberg, Germany;(2) University of Heidelberg, Department of Paediatric Radiology, Im Neuenheimer Feld 153, Heidelberg, 69120, Germany;(3) Paediatric Radiology, Children’s Hospital, University of Witten/Herdecke, Datteln, Germany;(4) Department of Surgical Paediatrics, Inselspital, University of Bern, Bern, Switzerland |
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Abstract: | Acute testicular torsion in children is an emergency and has to be diagnosed urgently. D oppler sonography is increasingly
used in imaging the acute scrotum. Nevertheless, in uncertain cases, surgical exploration is required. In this study, we attempted
to define the role of Doppler sonography in the diagnostic workup of the acutely painful scrotum. All patients admitted between
1999 and 2005 with acute scrotal pain were included. After clinical assessment, patients were imaged by Doppler sonography
with a ‘‘high-end’’ instrument. In cases of absent arterial perfusion of the testis in Doppler sonography, surgical exploration
was carried out. Patients with unaffected perfusion were followed clinically by ultrasound for up to 2 years. Sixty-one infants
and children aged 1 day to 17 years (median: 7.9 years) were included. In 14 cases, sonography demonstrated absent central
perfusion, with abnormal parenchymal echogenicity in six. Absence of venous blood flow together with reduction of central
arterial perfusion was found in one infant. In these 15 patients, surgical exploration confirmed testicular torsion. Among
the other 46 patients, we found four cases with increased testicular perfusion and 27 with increased perfusion of the epididymis.
In one infant, a testicular tumour was found sonographically, and orchiectomy confirmed diagnosis of a teratoma. Follow-up
examinations of the conservatively treated patients showed good clinical outcome with physiologic central perfusion as well
as normal echogenic pattern of both testes. No case of testicular torsion was missed. By means of Doppler sonography, an unequivocal
statement regarding testicular perfusion was possible in all cases. The initial Doppler diagnosis was confirmed by operative
evaluation and follow-up ultrasound. Testicular torsion can therefore be excluded by correctly performed ultrasound with modern
equipment.
Patrick Gunther and Jens-Peter Schenk contributed equally to this work |
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Keywords: | Acute scrotum Testicular torsion Sonography Child |
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