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Lee JSY, Chieng CH, Martin M, Toh TH. Spontaneous neonatal scrotal haematoma: an early manifestation of severe haemophilia. BMJ Case Rep 2021; 14:14/4/e241482. [PMID: 33910804 PMCID: PMC8094324 DOI: 10.1136/bcr-2020-241482] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
We report a term newborn who presented on day 3 of life with unilateral, tender scrotal swelling with skin discolouration, which was subsequently diagnosed as haemophilia A at about 6 months of age. He received intramuscular vitamin K and hepatitis B vaccine at birth uneventfully. The scrotal swelling was treated as an infected hydrocoele, considering the absence of a family history of bleeding disorder and other risks of bleeding tendency, as well as the ultrasonographic features. He also had congenital pneumonia requiring venepuncture, non-invasive oxygen supplementation and intravenous antibiotics, without any complication. The swelling slowly improved over 2 months. He later developed post-trial vaccine injection haematoma at 4 months of age, and multiple non-traumatic bruises when he was 6 months old, leading to the diagnosis. This case demonstrates an uncommon, but a possible, early manifestation of haemophilia A at birth with a unilateral scrotal haematoma.
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Affiliation(s)
- Jeffrey Soon-Yit Lee
- Clinical Research Centre, Sibu Hospital, Sibu, Sarawak, Malaysia .,Faculty of Medicine, SEGi University Kota Damansara, Petaling Jaya, Selangor, Malaysia
| | - Chae-Hee Chieng
- Faculty of Medicine, SEGi University Kota Damansara, Petaling Jaya, Selangor, Malaysia.,Department of Paediatrics, Sibu Hospital, Sibu, Sarawak, Malaysia
| | | | - Teck-Hock Toh
- Clinical Research Centre, Sibu Hospital, Sibu, Sarawak, Malaysia.,Faculty of Medicine, SEGi University Kota Damansara, Petaling Jaya, Selangor, Malaysia.,Department of Paediatrics, Sibu Hospital, Sibu, Sarawak, Malaysia
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Moh EN, Ake YL, Midekor KG, Kouassi SDAK, Azakpa L, Bonny R. Scrotal hematoma of the newborn in the tropics: What attitude? Afr J Paediatr Surg 2019; 16:40-42. [PMID: 32952141 PMCID: PMC7759079 DOI: 10.4103/ajps.ajps_17_17] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Scrotal hematoma (SH) in newborn is a rare condition. It can occur secondary to adrenal hemorrhage which often is associated with birth trauma. Scrotal hematoma often raises the suspicion of testicular torsion leading to unnecessary surgery. We report two cases which improved our management approach.
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Affiliation(s)
- Ello Nicolas Moh
- Department of Paediatric Surgery, UTHC of Cocody, Abidjan R.C.I, Abidjan 03, Côte d'Ivoire
| | - Yapi Landry Ake
- Department of Paediatric Surgery, UTHC of Cocody, Abidjan R.C.I, Abidjan 03, Côte d'Ivoire
| | - Kokoe Gonebo Midekor
- Department of Paediatric Surgery, UTHC of Cocody, Abidjan R.C.I, Abidjan 03, Côte d'Ivoire
| | - Sohie Dria A K Kouassi
- Department of Paediatric Surgery, UTHC of Cocody, Abidjan R.C.I, Abidjan 03, Côte d'Ivoire
| | - Leopold Azakpa
- Department of Paediatric Surgery, UTHC of Cocody, Abidjan R.C.I, Abidjan 03, Côte d'Ivoire
| | - Rebecca Bonny
- Department of Paediatric Surgery, UTHC of Cocody, Abidjan R.C.I, Abidjan 03, Côte d'Ivoire
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Gavrel M, Rafowicz A, d'Oiron R, Franchi-Abella S, Lambert T, Adamsbaum C. Imaging features of atypical bleeds in young patients with hemophilia. Diagn Interv Imaging 2018; 100:135-145. [PMID: 30559038 DOI: 10.1016/j.diii.2018.11.010] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2018] [Revised: 11/18/2018] [Accepted: 11/19/2018] [Indexed: 12/31/2022]
Abstract
Hemarthroses and muscle bleeds are well-known and well-documented complications in pediatric and young adult hemophilia patients. In contrast, deep bleeds in atypical locations can be a diagnostic challenge, since clinicians and radiologists are often unfamiliar with their clinical and radiological features. Some atypical bleeds, however, can be life-threatening or severely disabling, highlighting the need for prompt, accurate diagnosis. Rare bleeds include central nervous system bleeds (including intracranial and spinal hematomas), urogenital bleeds, intra-abdominal bleeds (mesenteric and gastrointestinal wall hematomas) and pseudo tumors in unusual locations like the sinonasal cavities. Because clinical assessment can be difficult, clinicians and radiologists should be aware of the possibility of these rare complications in their hemophilia patients, so that they can avoid unnecessary invasive diagnostic and surgical procedures and institute prompt, appropriate treatment. The purpose of this review is to illustrate the imaging features of bleeds that occur in rare locations in young (i.e., children and young adults) patients with hemophilia to make the reader more familiar with these conditions.
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Affiliation(s)
- M Gavrel
- Pediatric Radiology Department, Hôpitaux Universitaires Paris-Sud, Bicêtre AP-HP, 94270 Le Kremlin-Bicêtre, France.
| | - A Rafowicz
- Reference Centre for Hemophilia and Hemorrhagic Constitutional Diseases, Hôpitaux Universitaires Paris-Sud, Bicêtre AP-HP, 94270 Le Kremlin-Bicêtre, France
| | - R d'Oiron
- Reference Centre for Hemophilia and Hemorrhagic Constitutional Diseases, Hôpitaux Universitaires Paris-Sud, Bicêtre AP-HP, 94270 Le Kremlin-Bicêtre, France
| | - S Franchi-Abella
- Pediatric Radiology Department, Hôpitaux Universitaires Paris-Sud, Bicêtre AP-HP, 94270 Le Kremlin-Bicêtre, France
| | - T Lambert
- Reference Centre for Hemophilia and Hemorrhagic Constitutional Diseases, Hôpitaux Universitaires Paris-Sud, Bicêtre AP-HP, 94270 Le Kremlin-Bicêtre, France
| | - C Adamsbaum
- Pediatric Radiology Department, Hôpitaux Universitaires Paris-Sud, Bicêtre AP-HP, 94270 Le Kremlin-Bicêtre, France; Faculty of Medicine, Paris-Sud University, 94270 Le Kremlin-Bicêtre, France
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Sangüesa Nebot C, Llorens Salvador R, Picó Aliaga S, Garcés Iñigo E. Perinatal testicular torsion: Ultrasound assessment and differential diagnosis. RADIOLOGIA 2017. [DOI: 10.1016/j.rxeng.2017.02.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Sangüesa Nebot C, Llorens Salvador R, Picó Aliaga S, Garcés Iñigo E. Perinatal testicular torsion: ultrasound assessment and differential diagnosis. RADIOLOGIA 2017; 59:391-400. [PMID: 28117098 DOI: 10.1016/j.rx.2016.11.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2016] [Revised: 11/08/2016] [Accepted: 11/09/2016] [Indexed: 10/20/2022]
Abstract
Perinatal testicular torsion, defined as torsion occurring in the prenatal period or in the first month after birth, accounts for 10% of all cases of testicular torsion in pediatric patients. Most are extravaginal, and intravaginal torsion is rare. Its management is controversial, due to the low viability of the testis and the possibility of bilateral torsion. Ultrasonography is the method of choice to study testicular torsion. Combining B-mode and power Doppler imaging facilitates a fast reliable diagnosis. We review the ultrasonographic appearance of neonatal testicular torsion for each presentation, the differential diagnosis with other causes of increased scrotal volume in neonates, and its treatment.
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Affiliation(s)
- C Sangüesa Nebot
- Área de Imagen médica, Sección de Pediatría, Hospital Universitario y Politécnico La Fe, Valencia, España.
| | - R Llorens Salvador
- Área de Imagen médica, Sección de Pediatría, Hospital Universitario y Politécnico La Fe, Valencia, España
| | - S Picó Aliaga
- Área de Imagen médica, Sección de Pediatría, Hospital Universitario y Politécnico La Fe, Valencia, España
| | - E Garcés Iñigo
- Área de Imagen médica, Sección de Pediatría, Hospital Universitario y Politécnico La Fe, Valencia, España
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Xiao H, Gao Y, Li Y, Tang Y, Zhu L, Xu J, Mou F, Huang Y. Ultrasound assessment of perinatal testicular torsion. Br J Radiol 2016; 89:20151077. [PMID: 27278088 DOI: 10.1259/bjr.20151077] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
OBJECTIVE: The goal of this study was to elucidate the different sonographic features of prenatal and postnatal testicular torsion (TT) using high-frequency colour Doppler ultrasound (HCDU) in an effort to increase diagnostic accuracy. METHODS: 29 patients (average age, 7.5 days) with perinatal TT were divided into patients with postnatal (acute) TT vs patients with prenatal (chronic) TT and their clinical characteristics, imaging features on HCDU and surgical pathology results were retrospectively analyzed. RESULTS: Significant differences were observed between prenatal and postnatal TT cases with regard to testicular size (p = 0.01) and echogenicity (p = 0.007). All 17 prenatal cases had non-homogeneous testicular parenchymal echo patterns compared with only 9 (64.3%) postnatal TT cases. Five postnatal TT cases presented with homogeneous echo patterns compared with none of the prenatal TT cases. Testicular blood supply was absent in 25 (80.7%) of 31 testes on colour Doppler flow imaging, with the majority occurring in the prenatal TT cases [i.e. 16 (94.1%) cases]. 1 affected testis out of a total 17 testes from 16 patients with prenatal TT was salvaged, with a salvage rate of 1/17 or 0.06%. 7 affected testes out of a total 16 testes from 13 patients with postnatal neonatal TT were salvaged, with a salvage rate of 7/16 or 43.8%. CONCLUSION: In neonates with acute scrotal symptoms, the possibility of perinatal TT should be considered and HCDU examination should be performed in a timely manner. HCDU examination could aid in testicular salvage by prompting quick surgical intervention. ADVANCES IN KNOWLEDGE: This study underlined the clinical contribution of HCDU in evaluating postnatal (acute) vs prenatal (chronic) TT. The sonographic features of postnatal TT with salvageable testes were compared with prenatal torsion and the relative salvage rates in both cases were discussed.
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Affiliation(s)
- Huan Xiao
- 1 Department of Ultrasound, Children's Hospital of Chongqing Medical University, Chongqing, China.,2 Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing, China.,3 Key Laboratory of Pediatrics in Chongqing, Chongqing, China.,4 Chongqing International Science and Technology Cooperation Center for Child Development and Disorders, Chongqing, China
| | - Yang Gao
- 1 Department of Ultrasound, Children's Hospital of Chongqing Medical University, Chongqing, China.,2 Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing, China.,3 Key Laboratory of Pediatrics in Chongqing, Chongqing, China.,4 Chongqing International Science and Technology Cooperation Center for Child Development and Disorders, Chongqing, China
| | - Yingliang Li
- 2 Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing, China.,3 Key Laboratory of Pediatrics in Chongqing, Chongqing, China.,4 Chongqing International Science and Technology Cooperation Center for Child Development and Disorders, Chongqing, China.,5 Department of Pediatric Surgery, Children's Hospital of Chongqing Medical University, Chongqing, China
| | - Yi Tang
- 1 Department of Ultrasound, Children's Hospital of Chongqing Medical University, Chongqing, China.,2 Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing, China.,3 Key Laboratory of Pediatrics in Chongqing, Chongqing, China.,4 Chongqing International Science and Technology Cooperation Center for Child Development and Disorders, Chongqing, China
| | - Lirong Zhu
- 1 Department of Ultrasound, Children's Hospital of Chongqing Medical University, Chongqing, China.,2 Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing, China.,3 Key Laboratory of Pediatrics in Chongqing, Chongqing, China.,4 Chongqing International Science and Technology Cooperation Center for Child Development and Disorders, Chongqing, China
| | - Juan Xu
- 1 Department of Ultrasound, Children's Hospital of Chongqing Medical University, Chongqing, China.,2 Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing, China.,3 Key Laboratory of Pediatrics in Chongqing, Chongqing, China.,4 Chongqing International Science and Technology Cooperation Center for Child Development and Disorders, Chongqing, China
| | - Fangting Mou
- 1 Department of Ultrasound, Children's Hospital of Chongqing Medical University, Chongqing, China.,2 Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing, China.,3 Key Laboratory of Pediatrics in Chongqing, Chongqing, China.,4 Chongqing International Science and Technology Cooperation Center for Child Development and Disorders, Chongqing, China
| | - Yingle Huang
- 1 Department of Ultrasound, Children's Hospital of Chongqing Medical University, Chongqing, China.,2 Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing, China.,3 Key Laboratory of Pediatrics in Chongqing, Chongqing, China.,4 Chongqing International Science and Technology Cooperation Center for Child Development and Disorders, Chongqing, China
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Basta AM, Courtier J, Phelps A, Copp HL, MacKenzie JD. Scrotal swelling in the neonate. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2015; 34:495-505. [PMID: 25715370 PMCID: PMC4914382 DOI: 10.7863/ultra.34.3.495] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
Discovery of scrotal swelling in a neonate can be a source of anxiety for parents, clinicians, and sonologists alike. This pictorial essay provides a focused review of commonly encountered scrotal masses and mimics specific to the neonatal setting. Although malignancy is a concern, it is very uncommon, as most neonatal scrotal masses are benign. Key discriminating features and management options are highlighted to improve the radiologist's ability to diagnose neonatal scrotal conditions and guide treatment decisions. Neonatal scrotal processes ranging from common to uncommon will be discussed.
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Affiliation(s)
- Amaya M Basta
- Department of Radiology, Oregon Health & Science University, Portland, Oregon USA (A.M.B.); and Departments of Radiology and Biomedical Imaging ( J.C., A.P., J.D.M.) and Urology (H.L.C.), University of California, San Francisco, Benioff Children's Hospital, San Francisco, California USA.
| | - Jesse Courtier
- Department of Radiology, Oregon Health & Science University, Portland, Oregon USA (A.M.B.); and Departments of Radiology and Biomedical Imaging ( J.C., A.P., J.D.M.) and Urology (H.L.C.), University of California, San Francisco, Benioff Children's Hospital, San Francisco, California USA
| | - Andrew Phelps
- Department of Radiology, Oregon Health & Science University, Portland, Oregon USA (A.M.B.); and Departments of Radiology and Biomedical Imaging ( J.C., A.P., J.D.M.) and Urology (H.L.C.), University of California, San Francisco, Benioff Children's Hospital, San Francisco, California USA
| | - Hillary L Copp
- Department of Radiology, Oregon Health & Science University, Portland, Oregon USA (A.M.B.); and Departments of Radiology and Biomedical Imaging ( J.C., A.P., J.D.M.) and Urology (H.L.C.), University of California, San Francisco, Benioff Children's Hospital, San Francisco, California USA
| | - John D MacKenzie
- Department of Radiology, Oregon Health & Science University, Portland, Oregon USA (A.M.B.); and Departments of Radiology and Biomedical Imaging ( J.C., A.P., J.D.M.) and Urology (H.L.C.), University of California, San Francisco, Benioff Children's Hospital, San Francisco, California USA
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Reverse vertical transmission of hepatitis-B from transfusion-infected children to biological mothers. Indian Pediatr 2014. [DOI: 10.1007/s13312-014-0493-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
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Crisci V, Esposito C, Giurin I, Vitale V, Vallone G. Idiopathic scrotal hematoma simulating a testicular torsion, in association with cryptorchidism: US findings. Pol J Radiol 2014; 79:219-21. [PMID: 25061495 PMCID: PMC4108190 DOI: 10.12659/pjr.890915] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2014] [Accepted: 04/25/2014] [Indexed: 11/17/2022] Open
Abstract
Background An acute scrotum concerns endoscrotal organs (testicles, spermatic cord, tunica vaginalis) and is characterized by pain, swelling and hyperemia of the hemi-scrotum. It represents one of the most common surgical emergencies in children often caused by testicular torsion; the diagnosis is mostly clinical but must be supported by ultrasonographic examination of the scrotal region in association with a colour Doppler study of the spermatic cord vessels and glandular parenchyma. An idiopathic scrotal hematoma is a very rare condition that can simulate it. Case Report A 3-day-old full-term baby, otherwise in good health, showed swelling and pain of the left inguinal-scrotal region. A testicular torsion was suspected, so the baby underwent an ultrasound examination of the testis and spermatic cord that showed a left scrotal hematoma with superior displacement of the didymus; the right testicle was located in the internal inguinal canal. Surgical intervention confirmed the sonographic diagnosis of left testicular hematoma and of the right cryptorchidism. Conclusions Although testicular torsion is the most frequent cause of acute scrotum, the possibility of a persistent idiopathic scrotal haematoma and/or haematoma secondary to a trauma of the inguino-scrotal region, must be always taken into account. US diagnosis can avoid unnecessary emergency surgical treatment, required in case of testicular torsion.
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Affiliation(s)
- Vincenzina Crisci
- Department of Biomorphological and Functional Sciences, Section of Radiology, University Hospital Federico II, Naples, Italy
| | - Ciro Esposito
- Department of Tanslational Medical Sciences, "Federico II" University of Naples, Naples, Italy
| | - Ida Giurin
- Department of Tanslational Medical Sciences, "Federico II" University of Naples, Naples, Italy
| | - Valerio Vitale
- Department of Biomorphological and Functional Sciences, Section of Radiology, University Hospital Federico II, Naples, Italy
| | - Gianfranco Vallone
- Department of Biomorphological and Functional Sciences, Division of Pediatric Diagnostics, University Federico II of Naples, Naples, Italy
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Günther P, Rübben I. The acute scrotum in childhood and adolescence. DEUTSCHES ARZTEBLATT INTERNATIONAL 2012; 109:449-57; quiz 458. [PMID: 22787516 DOI: 10.3238/arztebl.2012.0449] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/16/2011] [Accepted: 03/28/2012] [Indexed: 11/27/2022]
Abstract
BACKGROUND The acute scrotum in childhood or adolescence is a medical emergency. Inadequate evaluation and delays in diagnosis and treatment can result in irreversible harm, up to and including loss of a testis. Various diseases can produce this clinical picture. The testis is ischemic in only about 20% of cases. METHODS This review is based on a selective literature search, the existing clinical guideline, and the authors' experience. RESULTS The clinical approach to the acute scrotum must begin with a standardized, rapidly performed diagnostic evaluation. Dopper ultrasonography currently plays a central role. Its main use is to demonstrate the central arterial blood supply and venous drainage of the testis. The resistance index of the testicular vessels should also be determined. CONCLUSION Physical examination and properly performed Doppler ultrasonography enable adequate evaluation of the acute scrotum in childhood and adolescence. In the rare cases of diagnostic uncertainty, immediate surgical exposure of the testis remains the treatment of choice.
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Affiliation(s)
- Patrick Günther
- Sektion Kinderchirurgie, Klinik für Allgemein-, Viszeral- und Transplantationschirurgie, Universitätsklinikum Heidelberg, Im Neuenheimer Feld 110, 69120 Heidelberg, Germany.
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Testicular torsion: sonomorphological appearance as a predictor for testicular viability and outcome in neonates and children. Pediatr Surg Int 2010; 26:281-6. [PMID: 19921212 DOI: 10.1007/s00383-009-2534-4] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/29/2009] [Indexed: 10/20/2022]
Abstract
INTRODUCTION Testicular torsion in children is found both in neonates [perinatal testicular torsion (PTT), <30th day of life] and in older children [testicular torsion (TT)]. Prediction of testicular viability is essential for deciding whether to perform emergency exploration surgery. The aim of the present study, therefore, was to investigate the sonomorphological parameters as predictors for testicular viability. MATERIALS AND METHODS All our cases of sonographically diagnosed and surgically confirmed testicular torsion (n = 25) in a 7.5-year period were reviewed. We evaluated the overall group and two subgroups, PTT (n = 9) and TT (n = 16), and assessed the following sonomorphological parameters: normal echogenicity (homogeneous), diffuse hyper-/hypoechogenicity (homogeneous) and focal hyper-/hypoechogenicity (heterogeneous). These findings were correlated with the testicular recovery rate. RESULTS In both groups, we found the highest recovery rates in testes with normal, homogeneous echogenicity and a zero recovery rate in testes with heterogeneous echogenicity (p = 0.0117). CONCLUSIONS By using the sonomorpohological criteria presented here, testicular viability can be appraised in all age groups to help determine the prognosis for testicular outcome. In PTT, a nonperfused, homogeneously appearing testis represents the initial phase of torsion. Only for this type is there hope for salvage. In addition to the intraoperative appearance, a testis that is preoperatively heterogeneous in appearance can support the decision for orchiectomy.
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Affiliation(s)
- H Barrett Fromme
- Section of Pediatrics, University of Chicago, Chicago, IL 60637, USA.
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Abstract
Torsion of the testis is a medical emergency that is most commonly encountered in adolescents. Patients usually present with sudden onset scrotal pain associated with nausea and vomiting. On physical examination the involved testis is tender, high riding and usually horizontal. The cremasteric reflex is usually absent. If left untreated irreversible ischaemia starts appearing in 6 h. Doppler ultrasound is the diagnostic imaging of choice. The ideal treatment is surgical exploration and orchidectomy with contralateral orchidopexy or bilateral orchidopexy depending on the condition of the affected testis. If surgical options are delayed then manual detorsion should be attempted.
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Abstract
Acute scrotum represents an emergency situation although testicular torsion is present in less than 20% of the cases. Sonography has meanwhile become the definitive modality for diagnosis. Its increasing use before surgical intervention has led to technical improvements in ultrasound diagnostics and critical assessment of ultrasound criteria to exclude testicular torsion as well as standardization of examination procedures. Central arterial and venous perfusion shown to be bilaterally equal on Doppler sonography is the most important criterion for excluding torsion. This article discusses other criteria such as the "resistance index," comparison of parenchymal structure of both testes, evidence for spermatic cord torsion, or differences between the sides in perfusion of the testicular parenchyma and highlights the difficulties involved in partial and intermittent testicular torsion. Alternative investigative methods and the significance of sonography in the differential diagnosis of other underlying causes are addressed. In summary, the combination of interpreting B-mode imaging, color Doppler, and power Doppler sonography and analyzing Doppler flow curves after clinical examination results in successful and conclusive evaluation of the testes in cases of acute scrotum in boys.
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Affiliation(s)
- P Günther
- Abt. Kinderchirurgie, Chirurgische Universitätsklinik Heidelberg, Im Neuenheimer Feld 110, 69120 Heidelberg.
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