Management of acute scrotum in children--the impact of Doppler ultrasound.
Links Management of acute scrotum in children--the impact of Doppler ultrasound. Schalamon J, Ainoedhofer H, Schleef J, Singer G, Haxhija EQ, Hollwarth MEJ Pediatr Surg. 2006 Aug;41(8):1377-80. Links Management of acute scrotum in children--the impact of Doppler ultrasound. Schalamon J, Ainoedhofer H, Schleef J, Singer G, Haxhija EQ, Hollwarth ME. Department of Pediatric Surgery, Medical University of Graz, 8036 Graz, Austria. johannes.schalamon@meduni-graz.at BACKGROUND: Investigation of the value of scrotal Doppler ultrasound (DUS) in the diagnosis of acute scrotum and its impact on the treatment strategy was undertaken. METHOD: Seventy-nine children (mean age, 9.2 years) with acute scrotum were prospectively studied. The protocol included history, clinical examination, scrotal DUS, and standard laboratory analysis. Depending on scrotal DUS findings, the children were treated either nonoperatively (normal or increased testicular blood flow) or surgically (reduced or absent testicular blood flow). A follow-up investigation 6 weeks after discharge included a scrotal DUS. RESULTS: In 66 children (84%), the result of DUS determined the management; 26 children with hyperperfusion (epididymitis and orchitis), 18 children with appendix testis torsion (ATT), and 9 children with normal perfusion (edema and hematoma) were treated nonoperatively. The follow-up examination revealed no testicular atrophy and confirmed the primary diagnosis. Ten children without testicular perfusion and suspected torsion and 3 children with orchitis and pyocele were surgically explored, and again, the initial DUS diagnosis was verified. In the remaining 13 patients (16%), the result of the ultrasound examination was unclear. Of these, 6 children were noncompliant and refused to undergo ultrasonography. Another 4 children were explored because of persistence of symptoms. In 3 additional patients, a testicular tumor was suspected. All these 13 children underwent surgical exploration, revealing inflammation (epididymitis) in 6 children and acute ATT in 4 children, whereas the suspected tumor emerged as postacute ATT in 3 boys. CONCLUSION: In 84% of children with acute scrotal pain, the DUS was able to differentiate between surgical emergencies and other etiologies. In 16% of our pediatric patients, the DUS remained unclear, thereby necessitating surgical exploration. PMID: 16863840 [PubMed - indexed for MEDLINE] Related Links Critical validation of colour Doppler ultrasound in diagnostics of acute scrotum in children. [Eur J Pediatr Surg. 2003] PMID: 14743326 The normal and abnormal scrotum in children: evaluation with color Doppler sonography. [AJR Am J Roentgenol. 1992] PMID: 1739005 Clinical and sonographic criteria of acute scrotum in children: a retrospective study of 172 boys. [Pediatr Radiol. 2005] PMID: 15503003 Scrotal pathology in pediatrics with sonographic imaging. [Curr Probl Diagn Radiol. 2000] PMID: 11104171 Color Doppler imaging in the diagnosis of the acute scrotum. [Eur Urol. 1997] PMID: 9412806 See all Related Articles... Display Summary Brief Abstract AbstractPlus Citation MEDLINE XML UI List LinkOut ASN.1 Related Articles Cited Articles Cited in Books CancerChrom Links Domain Links 3D Domain Links GEO DataSet Links Gene Links Gene (GeneRIF) Links Genome Links Project Links GENSAT Links GEO Profile Links HomoloGene Links Nucleotide Links Nucleotide (RefSeq) Links OMIA Links OMIM (calculated) Links OMIM (cited) Links BioAssay Links Compound Links Compound via MeSH Substance Links Substance via MeSH PMC Links Cited in PMC PopSet Links Probe Links Protein Links Protein (RefSeq) Links SNP Links Structure Links Taxonomy via GenBank UniGene Links UniSTS Links Show 5 10 20 50 100 200 500 Sort by Pub Date First Author Last Author Journal Send to Text File Printer Clipboard E-mail Order .
Department of Pediatric Surgery, Medical University of Graz, 8036 Graz, Austria. johannes.schalamon@meduni-graz.at
BACKGROUND: Investigation of the value of scrotal Doppler ultrasound (DUS) in the diagnosis of acute scrotum and its impact on the treatment strategy was undertaken. METHOD: Seventy-nine children (mean age, 9.2 years) with acute scrotum were prospectively studied. The protocol included history, clinical examination, scrotal DUS, and standard laboratory analysis. Depending on scrotal DUS findings, the children were treated either nonoperatively (normal or increased testicular blood flow) or surgically (reduced or absent testicular blood flow). A follow-up investigation 6 weeks after discharge included a scrotal DUS. RESULTS: In 66 children (84%), the result of DUS determined the management; 26 children with hyperperfusion (epididymitis and orchitis), 18 children with appendix testis torsion (ATT), and 9 children with normal perfusion (edema and hematoma) were treated nonoperatively. The follow-up examination revealed no testicular atrophy and confirmed the primary diagnosis. Ten children without testicular perfusion and suspected torsion and 3 children with orchitis and pyocele were surgically explored, and again, the initial DUS diagnosis was verified. In the remaining 13 patients (16%), the result of the ultrasound examination was unclear. Of these, 6 children were noncompliant and refused to undergo ultrasonography. Another 4 children were explored because of persistence of symptoms. In 3 additional patients, a testicular tumor was suspected. All these 13 children underwent surgical exploration, revealing inflammation (epididymitis) in 6 children and acute ATT in 4 children, whereas the suspected tumor emerged as postacute ATT in 3 boys. CONCLUSION: In 84% of children with acute scrotal pain, the DUS was able to differentiate between surgical emergencies and other etiologies. In 16% of our pediatric patients, the DUS remained unclear, thereby necessitating surgical exploration.
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