Role Of Ultrasound With Color Doppler In Diagnostic Evaluation Of Acute Scrotum

Abstract

Background & Objectives: Acute scrotum has different causes & etiological factors. Although some causative factors like epididymo-orchitis can be treated with medical management, but some conditions like torsion, incarcerated hernia & fournier’s gangrene require immediate surgical intervention to treat the patient. Ultrasound with color Doppler is a significant tool to rule out these etiologies for acute scrotum & it helps to take a proper decision for the benefit of patient. This modality is cheap, easily available and does not cause exposure of radiation to gonads. So it can be utilized for the diagnosis in such cases. This study was done to find out the diagnostic capability of ultrasound and color Doppler in acute scrotum cases. Methods: Patients of acute scrotal pain who came to Shri B. M. Patil medical college, Hospital and Research centre, Vijaypur, Karnataka and referred to Department of Radiology for sonographic evaluation were taken for study. It was conducted from November 2015 to April 2017. Patient was examined in supine position. A rolled sheet was placed between legs for scrotal support. A high-frequency probe was used for scanning in transverse and sagittal planes. Lower frequency transducer was used in cases of enlarged scrotal sac. Echotexture & vascularity of both the testis & epididymis were evaluated. Siemens Acuson X700 and Philips HD11-XE. Results: In our study of 50 patients presenting with acute scrotum, 5 cases were of torsion. Epididymo-orchitis was diagnosed in 36 cases. Incarcerated hernia was present in 2 cases & 7 cases were of varicocele. To confirm the diagnosis, follow up of surgical or medical management was taken. One case of epididymo-orchitis was misdiagnosed which further proved to be varicocele. Rest cases were correct in the diagnosis. Interpretation & Conclusion: In our study, whirlpool sign with absence of vascularity in distal spermatic cord and testis was the key finding for torsion cases. Increased vascularity in epididymis & testis were the indicative parameters for epididymo-orchitis. For incarcerated hernia, the diagnostic point was akinetic bowel loop in the inguino scrotal region with absent or minimal vascularity of that bowel loop. For varicocele, dilated venous channels with reflux on valsalva maneuver was considered. Ultrasound with color Doppler is an excellent modality for diagnos