Uses for Ultrasound – Part 3
The acutely painful scrotum can be a diagnostic dilemma for emergency room physicians and urologists alike. If this condition is accompanied by a palpable mass a malignancy must be first on the list of possible diagnoses.
In the absence of a mass, the diagnosis of testicular torsion and epididymitis and/or orchitis must
be entertained. Testicular torsion is the twisting of the testes inside the scrotum on its vascular pedicle (the artery and vein that it is suspended from). Epididymitis is an inflammation of the epididymis, which is the structure that sits on the top of the testes that takes part in ejaculation of sperm and semen. Orchitis is inflammation of the testes.
Testicular torsion is a surgical emergency. Epididymitis and orchitis is treated with antibiotics and warm soaks. The test of choice is a nuclear medicine scan performed with technetium 99m sodium pertechnate. However, if this is not immediately available an ultrasound test using pulsed Doppler waveform findings, color flow, and morphololgy done by an experienced ultrasonographer can also be used to make the diagnosis of testicular torsion.
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