Ultrasound: testicular: Difference between revisions

Revision as of 13:59, 15 August 2016

Background

Testicular torsion is a medical emergency where acute treatment is needed
Testicular salvage rate by time

Patriquin HB, Yazbeck S, Trinh B, et al. Testicular torsion in infants and children: diagnosis with Doppler sonography. Radiology. 1993;188:781-785.

- Near 100% within 6 hours
- 70% within 6-12 hours
- 20% within 12-24 hours

Anatomy

Testicle - ~2 to 3 cm in width and 3 to 5 cm in length
Epididymis - along the posterolateral aspect of each testis
Vas Deferens
Spermatic cord
Median Raphe

Indications

Testicular pain or tenderness
Testicular swelling

Technique

Select probe
- Linear probe
Location
- Obtain anterior views over the scrotum
Landmarks
- Heterogeneous testicles can be seen under the soft tissues of the scrotum
Obtain sagittal and transverse images
- Initial view should be “buddy view” identifying both testicles in a tranverse plane with the middle of the probe over the scrotal raphe
- Each testicle should be examined in the transverse and sagittal plane
- Each testicle should be examined under power Doppler assessing blood flow
Optimize image quality
- Minimize depth to include only the body of the testicle
- When assessing blood flow, increase power Doppler to a level where vasculature can be easily identified

Findings

Normal Testicle

*Equal heterogeneity

Equal blood flow
Minimal fluid around the testicle

Testicular Torsion

Enlarged testicle
Increased heterogeneity
Decreased flow on power Doppler
- Increased flow may be seen in cases of torsion with subsequent detorsion

Epididymitis

Enlarge epididymis
Increased epididymal blood flow
Normal testicular appearance

Orchitis

Enlarged testicle
Increased flow on power Doppler
Difficult to differentiate from recently detorsed testicle

Images

Normal

Abnormal

Pearls and Pitfalls

Adjust color flow on normal testicle first as a baseline to compare to painful or swollen testicle
Hyperemic testicle does not rule out testicular torsion as this could represent intermittent torsion or detorsion

Documentation

Normal Exam

A bedside ultrasound was conducted to assess for signs testicular torsion with clinical indications of right/left testicular pain. The right and left testicles were identified and viewed in the transverse and sagittal plane and assessed with power Doppler. Heterogenicity was similar and blood flow was similar. There was not indications of testicular torsion.

Abnormal Exam

A bedside ultrasound was conducted to assess for signs testicular torsion with clinical indications of right/left testicular pain. The right and left testicles were identified and viewed in the transverse and sagittal plane and assessed with power Doppler. The right/left testicle has increased heterogenicity and diminished blood flow. Findings indicate testicular torsion.

Clips

Normal

[File:Normal testicular flow.gif|250px|Normal testicular blood flow]]

Abnormal

Testicular Torsion

External Links

Sonoguide: Small Parts - Testicular Ultrasound

References

Authors:

@@ Line 1: / Line 1: @@
-==Anatomy==
+==Background==
+*Testicular torsion is a medical emergency where acute treatment is needed
+*Testicular salvage rate by time
+Patriquin HB, Yazbeck S, Trinh B, et al. Testicular torsion in infants and children: diagnosis with Doppler sonography. Radiology. 1993;188:781-785.
+**Near 100% within 6 hours
+**70% within 6-12 hours
+**20% within 12-24 hours
+===Anatomy===
 *Testicle - ~2 to 3 cm in width and 3 to 5 cm in length
 *Epididymis - along the posterolateral aspect of each testis
@@ Line 5: / Line 12: @@
 *Spermatic cord
 *Median Raphe
+==Indications==
+*Testicular pain or tenderness
+*Testicular swelling
 ==Technique==
-*Linear Transducer
+#Select probe
-*Scanned in longitudinal and transverse axis
+#*Linear probe
-*First the unaffected hemiscrotum
+#Location
-*Coronal scan showing both testicles side by side (Buddy View) should be performed to identify differences in size and echogenicity, and vascularity
+#*Obtain anterior views over the scrotum
-*Power Doppler examination on unaffected side for calibration of machine
+#Landmarks
+#*Heterogeneous testicles can be seen under the soft tissues of the scrotum
+#Obtain sagittal and transverse images
+#*Initial view should be “buddy view” identifying both testicles in a tranverse plane with the middle of the probe over the scrotal raphe
+#*Each testicle should be examined in the transverse and sagittal plane
+#*Each testicle should be examined under power Doppler assessing blood flow
+#Optimize image quality
+#*Minimize depth to include only the body of the testicle
+#*When assessing blood flow, increase power Doppler to a level where vasculature can be easily identified
+==Findings==
+===Normal Testicle===
+ *Equal heterogeneity
+*Equal blood flow
+*Minimal fluid around the testicle
+===[[Testicular Torsion]]===
+*Enlarged testicle
+*Increased heterogeneity
+*Decreased flow on power Doppler
+**Increased flow may be seen in cases of torsion with subsequent detorsion
+===[[Epididymitis]]===
+*Enlarge epididymis
+*Increased epididymal blood flow
+*Normal testicular appearance
+===[[Hydrocele]]===
+*Anechoic fluid adjacent to the testicle
+===[[Orchitis]]===
+*Enlarged testicle
+*Increased flow on power Doppler
+*Difficult to differentiate from recently detorsed testicle
+==Images==
+===Normal===
+[[File:Normal testicular flow.JPG|250px]]
+===Abnormal===
+===[[Testicular Torsion]]===
+[[File:Testicular torsion.png|250px]]
+===[[Epididymitis]]===
+[[File:Epidydimitis.png|250px]]
+===[[Hydrocele]]===
+[[File:Small hydrocele.png|250px|White arrow]]
+==Pearls and Pitfalls==
+*Adjust color flow on normal testicle first as a baseline to compare to painful or swollen testicle
+*Hyperemic testicle does not rule out testicular torsion as this could represent intermittent torsion or detorsion
-==Terms==
+==Documentation==
-*Hyperemia: inflammation and demonstrates increased flow (lots of color) compared to contralateral side
+===Normal Exam===
-**Think -itis and detorsed testicle
+A bedside ultrasound was conducted to assess for signs testicular torsion with clinical indications of right/left testicular pain. The right and left testicles were identified and viewed in the transverse and sagittal plane and assessed with power Doppler. Heterogenicity was similar and blood flow was similar. There was not indications of testicular torsion.
+===Abnormal Exam===
+A bedside ultrasound was conducted to assess for signs testicular torsion with clinical indications of right/left testicular pain. The right and left testicles were identified and viewed in the transverse and sagittal plane and assessed with power Doppler. The right/left testicle has increased heterogenicity and diminished blood flow. Findings indicate testicular torsion.
-==Findings and DDX==
+==Clips==
-*[[Epididymitis]] - enlarged epididymis with decreased echogenicity
+===Normal===
-*[[Orchitis]] - enlarged testicle with heterogeneous echogenicity with increased blood flow
+[File:Normal testicular flow.gif|250px|Normal testicular blood flow]]
-*[[Hydrocele]] -  Abnormal collection of fluid in the space between the visceral and parietal layers of the tunica vaginalisin anterolateral portions
+===Abnormal===
-*[[Varicocele]] -  left side, multiple anechoic serpiginous tubular or curvilinear structures of varying sizes (larger than 2 mm in diameter)
+====Testicular Torsion====
-*[[Testicular torsion]] - Power Doppler with absent blood flow in the affected testicle; patient can present early and still have flow
+[[File:Testicular torsion.gif|250px|Absent testicular blood flow]]
-*[[Torsion of testicular appendage]]
-*[[Testicular trauma]]
-*Herniation of abdominal contents into the scrotum - peristalsis of bowel
+==External Links==
+*[http://www.sonoguide.com/smparts_testicular.html Sonoguide: Small Parts - Testicular Ultrasound]
 ==See Also==
 *[[Ultrasound (Main)]]
@@ Line 33: / Line 90: @@
 ==References==
 <references/>
-*Sonosite - Last Accessed 12/30/14
+[[Category:Ultrasound]]
+[[Category:Radiology]]
 [[Category:Urology]]
-[[Category:Radiology]]
-[[Category:Ultrasound]]