Reliability of colour Doppler ultrasound in the differential diagnosis of acute scrotum

Abstract

Acute scrotum, when testicular torsion is suspected, needs emergency exploration. However, acute scrotum caused by torsion of the Morgagni hydatid and epididymitis can be managed conservatively. Real time colour Doppler ultrasound is becoming a more and more popular tool in the differential diagnosis, however, its reliability is still not widely accepted and exploration is preferred. Case notes of 124 patients treated with acute scrotum during the last 10 years have been reviewed, and the result of physical examination, color Doppler ultrasound, operative notes and clinical outcome were analysed. The final diagnosis was torsion of Morgagni hydatid in 100 cases, furthermore 11 testicular torsion, 8 epididymitis and 10 idiopathic cases were identified. Preoperative colour Doppler ultrasound was done in 45 cases, and exploration was performed in 111 cases. In 38 cases the colour Doppler ultrasound excluded and in 7 cases verified the possibility of testicular torsion. Two false positive and 0 false negative cases were identified. The specificity was 95.0%, sensitivity 100.0%, negative predictive value 100.0%, and positive predictive value 71.4%. Colour Doppler ultrasound seems to be a reliable tool in the differential diagnosis of acute scrotum. Its routine use could reduce the number of emergency explorations.