Scrotal Abnormalities Research Articles

Acute scrotal abnormalities in children: Diagnosis by combined sonography and scintigraphy

Acute scrotal abnormalities in children: Diagnosis by combined sonography and scintigraphy

MRI of the scrotum.

Surface coil magnetic resonance (MR) imaging of the scrotum allows differentiation of the testis, epididymis, and spermatic cord. Intratesticular and extratesticular lesions are demarcated by the tunica albuginea. The sensitivity of MR is very high for detection of scrotal abnormalities but is non-specific since it is unable to distinguish primary testicular tumors from benign lesions. Undescended testes which lie proximal and distal to the internal inguinal ring are well visualized by MR imaging. The advantages of MR imaging in locating undescended testes is that it is noninvasive, without ionizing radiation, and capable of multiplanar images.

Acute scrotal abnormalities in children: diagnosis by combined sonography and scintigraphy.

Both scintigraphy and real-time sonography have been used to assess acute symptoms involving the scrotum. However, because of its high sensitivity and ability to document physiologic abnormalities, scintigraphy has been the procedure of choice. Scintigraphy, however, lacks specificity; its value lies mainly in serving to distinguish torsion from nontorsion. The purpose of this study was to supplement scrotal scintigraphy with sonography to determine if the combination improves diagnosis and management compared with scintigraphy alone. Forty-three scrotal scintigrams and sonograms were performed on 40 consecutive patients with acute scrotal symptoms. The interpretation of the scintigram was altered by sonography in six (14%) of the combined scans, directly affecting clinical management. In three patients with acute hydroceles diagnosed by sonography, exploratory surgery was avoided despite scintigraphic findings suggesting testicular torsion. Scintigraphy was normal in two patients with spontaneous testicular detorsion, whereas sonography showed recent spermatic-cord torsion that required subsequent orchiopexy. In a patient with epididymitis and orchitis, sonography showed a complicating scrotal abscess, which was not apparent on scintigraphy and which required antibiotic treatment. The addition of sonography to the scintigraphic evaluations of children with acute scrotal abnormalities changed the diagnosis and clinical management in 14% of the patients studied.

MR imaging of the scrotum with a high-resolution surface coil.

Magnetic resonance (MR) imaging of the scrotum with a high-resolution surface coil was performed in ten healthy volunteers and 20 patients with scrotal abnormalities demonstrated by high-resolution real-time ultrasound (US). Four patients had an abnormal testis (two tumors, one cyst, one testicular atrophy), and 16 patients had extratesticular abnormalities (four hydroceles, five epididymal cysts, one hernia, and six cases of epididymitis). The normal structures of the scrotum were depicted clearly on MR images. In all cases, the tunica albuginea was easily differentiated from the testis and epididymis. MR imaging enabled one to distinguish intratesticular from extratesticular lesions and to determine whether a lesion was solid or cystic. Complicated and simple fluid collections could also be differentiated. In general, MR imaging and US scanning provided similar information. A potential advantage of MR imaging is in the evaluation of patients with painful scrotal lesions that may limit US evaluation.

High Resolution Sonography in Diagnosing Testicular Neoplasms: Clinical Significance of False Positive Scans

We describe the use of high resolution real-time ultrasound to evaluate scrotal masses. From August 1980 to September 1984, 249 patients underwent scrotal ultrasound using high resolution real-time scanners with 10mHz. transducers to evaluate scrotal abnormalities. The ultrasound diagnosis was consistent with a testicular neoplasm in 20 patients. Pathological and surgical confirmation was available in all 20 patients. Only 10 of 20 patients had malignant tumors, whereas 10 had benign lesions (false positive rate of 50 per cent). Testicular lesions producing false positive studies were principally hypoechoic in 8 patients and hyperechoic in 2. Testicular neoplasms characteristically were hypoechoic with or without focal hyperechoic areas. There was 1 false negative ultrasound study. Our results suggest that radical orchiectomy should not be performed indiscriminately in all patients with testicular lesions that are sonographically suspicious for neoplasm. In selected cases with hyperechoic sonographic features associated frequently with benign testis lesions open testicular biopsy and a testis-sparing operation may be indicated.

Ultrasound examination of the scrotum.

The technique of real time ultrasound examination of the scrotum is described. The examination was performed on 120 patients and was found to be a helpful diagnostic aid in scrotal swelling and in the acute painful scrotum. It is recommended as a useful investigation for scrotal abnormalities.

Sonography of Acute Scrotal Abnormalities

Accurate diagnosis in patients with acute scrotal abnormalities remains a challenge to both radiologists and clinicians. Sonography using either small parts scanners or conventional equipment available in almost all departments will continue to play a larger role in aiding the clinical assessment of these patients. As a rapid, noninvasive imagining technique, sonography can reliably answer important clinical questions and guide prompt, early surgical or medical therapy.

High-frequency scrotal sonography.

High-frequency real-time sonography has enhanced accuracy in the diagnosis of scrotal abnormalities. Results of 48 scrotal scans of 92 testes are presented. There were 22 testicular lesions, nine seminomas, four embryonal cell carcinomas, one case of metastatic prostatic carcinoma, one benign "keratin cyst," three testicular infarcts, three atrophied testes, and one case of testicular torsion. Hypoechoic tumors and infarcts have a similar appearance. Extratesticular abnormalities included spermatoceles, varicoceles, epididymitis, hydroceles, and a scrotal hematoma. Sonography accurately distinguished between testicular and extratesticular masses in all cases in this series and pathologic correlations were obtained for all testicular masses. Simultaneous real-time contact scanning and palpation facilitated accurate diagnosis.

Prospective analysis of the value of scrotal ultrasound.

Ultrasound was evaluated in 69 patients for its usefulness in distinguishing scrotal abnormalities requiring surgery from those that may have clinical follow-up only. Distinction was possible in the majority of cases. On imaging, tumor showed decreased echogenicity within the testicle, which was usually enlarged. Epididymal enlargement, marked increase in peritesticular fluid, and skin thickening suggest a non tumorous condition. The ultrasound characteristics of various scrotal abnormalities are described.

Scrotal abnormalities in rams in tropical Queensland with particular reference to ovine brucellosis and its control.

SummaryClinical conditions affecting the reproductive organs were found affecting 17.2% of 2,332 rams. The following conditions were found: epididytimis 69.4%, atrophy 15.4%, varicocoele 9.5%, hernia 2.9%, cryptorchidism 1.2%, and hydrocoele 1.5%. The incidence of Brucella ovis antibodies as determined by the CF test in 2,332 rams from 12 flocks in north western Queensland was found to be 18.3%.The age distribution of ovine brucellosis among 1,772 rams whose ages were known was as follows: 1 year 2.1%, 2 years 10.4%, 3 years 15.9%, 4–7 years 21.8%, and over 7 years 24.4%. The age incidence of all the various clinical conditions as they affected the 1,772 rams was: 1 year 3.6%, 2 years 8.4%, 3 years 13.1%, 4–7 years 28.4%, and over 7 years 27.9%.Control of brucellosis in two flocks is reported and a possible means of control of this disease in Queensland is discussed.

Siblings with different types of chromosal aberrations due to D-E-translocation of the mother.

A woman of normal appearance had an abortion and gave birth to two mentally defective children with different malformations. A fourth pregnancy was interrupted legally. Features of the first child resemble those of the D trisomy syndrome and the second child has some characteristics in common with cases of E trisomy syndrome. The common symptoms are mental deficiency, short stature, flexion of the fingers and a mild scrotal abnormality. The chromosomes were examined in some members of the family. In the mother, it is presumed that one part of a chromosome of group D has been translocated to a chromosome 17, giving a large chromosome in the group C size range. The other fragment of the broken chromosome resembles the chromosomes of group G. The mother presumably has the normal, although rearranged, genetic material in each cell. The two children reflect the two possible types of partial D trisomy derivable from the mother’s karyotype. Child 1 has the large D/E translocation chromosome with only one chromosome 17. Child 2 has 47 chromosomes since the proximal part of the involved maternal chromosome D has been inherited as an extra chromosome. Since a reciprocal translocation is possibly involved, then child 2 may be trisomic not only for part of a D chromosome but also for a region of chromosome 17. The clinical picture supports this possibility. The karyotypes of the embryo and the mother are identical. The chromosomes are normal in the maternal grandmother and in the father of children 1 and 2. The chromosome number is 46 in a maternal aunt, but two out of 18 mitoses examined have an abnormal karyotype.

Inguinal Hernias in Children

The inguinal hernia repair account among surgical procedures the most frequently performed in children. Most inguinal hernias in infants and children are indirect due to patent processus vaginalis. Failure of closure of the processus vaginalis accounts for nearly all the inguino scrotal abnormalities seen in infancy and childhood. In little girls, the processus (canal de Nuck) may remain patent and may allow the ovary and fallopian tube to enter the inguinal region. Incarceration represents the most common complications associated (30 per-cent during the first year of life). Consequences concern in the first place the testicular blood supply before to interest the vitality of the incarcerated intestine. The surgically repair is recommended shortly after the diagnosis. The concurrence rate of recurrent inguinal hernia after uncomplicated inguinal hernia repairs is generally reported at 0.5-1 per cent, increasing for premature infant and complicated inguinal hernia.