Suspicion Of Testicular Torsion Research Articles

The impact of ultrasound on testicular loss in cases of testicular torsion in children

PurposeUltrasound as a diagnostic tool in suspicion of testicular torsion is still highly debated. In this investigation, we aimed to evaluate whether time spent on scrotal ultrasonography had a negative impact on testicular loss.MethodsPatients’ records containing a scrotal ultrasound and/or surgical procedure codes for testicular interventions on suspicion of testicular torsion were examined. Patients aged 0–15 years admitted during 2015–2019 at Copenhagen University Hospital, Rigshospitalet were included.ResultsIn total, 1566 patients underwent an ultrasound and 142 of these proceeded to surgery while 13 patients proceeded directly to surgery without an ultrasound. The rate of testicular loss with a preceding ultrasound was 23% versus 42% without (p = 0.18). Four cases of testicular torsion were misdiagnosed by ultrasound resulting in a sensitivity of 95.4% and specificity of 95.6%. The mean diagnostic delay from ultrasound examination was 55 ± 39 min, and the mean time from ultrasound to surgery was at 169 ± 76 min versus 171 ± 72 min without ultrasound.ConclusionIn a clinical setting, ultrasound provided a reliable tool for the diagnosis of testicular torsion and did not seem to increase the orchiectomy rate.

Detection of Testicular Torsion With Preserved Intratesticular Flow By Point of Care Ultrasound in the Emergency Department: A Case Report

BackgroundUltrasonography is an effective diagnostic tool for testicular torsion (TT), which is typically characterized by the absence of blood flow in the affected testicle on color Doppler mode. However, there are a few reported cases of TT with symmetrical preserved flow. We report a case of TT with the preserved intratesticular flow on color Doppler ultrasound. Case ReportA 14-year-old boy was admitted due to sudden-onset right scrotal pain. Point-of-care ultrasound (POCUS) revealed that the right testicle was larger than the left. The intratesticular flow in both testicles was preserved. Radiology-performed ultrasound confirmed the preserved intratesticular flow observed on POCUS, but also demonstrated a whirlpool sign of the right spermatic cord. TT was confirmed surgically. Why Should an Emergency Physician Be Aware of This?Emergency physicians should investigate the presence of intratesticular blood flow and the whirlpool sign of the spermatic cord or other ultrasound features suggestive of TT, even if testicular blood flow is preserved. Suspicion of TT from POCUS findings warrants further evaluation to preserve the patient's fertility.

Hemoptisis de etiología desconocida. Informe de caso

Introducción: La hemoptisis es una cantidad variable de sangre que pasa por la glotis proveniente de las vías aéreas y de los pulmones.
 Caso Clínico: Hombre, 32 años, obeso, tabaquista, ingresó por disnea de moderados a mínimos esfuerzos de 4 meses de evolución. El paciente refirió tos con expectoración hemoptoica de 05 años de evolución, predominio nocturno, constatada al despertar. Refirió haberse sometido a varios procedimientos quirúrgicos: por sospecha de torsión testicular, lamectomía descompresiva y extracción de aguja de costura en región parietal posterior a una TAC por episodios tónico-clónicos. Durante su internación, se le realizaron varios exámenes todos sin éxito. Un día, se identificó actitud sospechosa, comprobándose la ingesta de sangre del conducto de poliflex, la cual colaboró con el diagnóstico definitivo de “síndrome facticio”.
 Discusión: Como parte de la salud integral no debemos olvidar la evaluación de la salud mental y hacer más hincapié en la historia clínica.

Scrotal exploration for acute scrotal pain: A 10-year experience in two tertiary referral paediatric units

Objective.Acute scrotal pain is a common presentation to the paediatric emergency department. Testicular torsion is one of the most common causes of acute scrotal pain. Testicular torsion is a surgical emergency requiring immediate surgical exploration to prevent permanent testicular damage or loss. The aim of this study was to determine the surgical outcome of all scrotal explorations and to assess the use of colour Doppler ultrasound (CDUS) in the assessment of acute scrotal pain in two tertiary referral paediatric units. Material and methods. A retrospective review of a prospectively maintained database was carried out for all scrotal explorations between 1999 and 2010. Results.In total, 155 scrotal explorations were carried out for acute scrotal pain. The mean age was 9.1 years (range 0–15 years). The pathology in 46.5% (n = 72) was testicular torsion, 30.3% (n = 47) were torsion of a testicular appendage, 16.1% (n = 25) were epididymitis, 3.3% (n = 5) had no obvious pathology identified and other pathology accounted for 4%. There was a significant difference in age of presentation between those with testicular torsion and those with torsion of a testicular appendage (9 vs 10 years, p = 0.0074). CDUS was performed by a trained radiologist on 40 patients. Overall sensitivity, specificity, positive predictive value and negative predictive value for CDUS predicting testicular torsion were 96.9%, 88.9%, 96.9% and 89%, respectively. Overall, 36 patients (23%) with acute scrotal pain (50% of patients in the group with confirmed testicular torsion at exploration) required orchidectomy. Conclusion. This study supports the practice of immediate surgical exploration with a clinical suspicion of testicular torsion in a paediatric population.

Article

A 25-year-old man from Bangla Desh with acute right scrotal pain was subjected to scrotal surgical exploration because of the suspicion of testicular torsion. The testicle appeared normally positioned; an epididymal nodule was removed, and pathology showed the presence of the filaria worm. Filariasis is a tropical disease which has been estimated to affect 120 millions people throughout the world. Lymphadenitis and lymphangitis are the more common clinical settings; in men, there is a frequent scrotal involvement. In some cases, acute scrotal pain may lead to the suspicion of testicular torsion. The observation of patients with genital filariasis is likely to become more frequent in an era of massive immigration from different countries; nowadays, the disease should always be taken into consideration in the differential diagnosis in patients with acute scrotal pain coming from tropical areas.

Acute scrotum - Etiology and management.

Acute scrotal pain is a common urological emergency. Urgent exploration is the standard means of management, since no investigation can confidently exclude torsion of testis from the differential diagnosis. A review of all boys presenting with acute scrotal pain who underwent emergency scrotal exploration between January 1983 and March 2003 was performed. 195 boys were included in this study. They were divided into 3 groups: group 1-73 with epididymo-orchitis, group 2-63 with torsion of testicular appendages and group 3-57 with spermatic cord torsion. The patients in group 2 were older than group 1, also patients in group 1 were older than group 3. During neonatal period the most common pathology was spermatic cord torsion, whereas in prepubertal period torsion of appendages was more common. In all boys, mean duration of pain at presentation was 2.11 days. Epididymo-orchitis was diagnosed in 37% of patients, with torsion of the appendages being the next most common entity. Testicular torsion was diagnosed in 29% of patients. In the group with testicular torsion salvage rate of testis was 37% because of late admission. The perioperative morbidity and mortality was not seen in any of the groups. We believe that any boy with acute scrotal pain and any suspicion of testicular torsion in physical examination must be applied routine surgical exploration.

Salmonella enteritidis orchitis in a 10–week‐old boy

Extraintestinal manifestations of salmonellosis in paediatric patients are found predominantly in infants less than three months of age. Genital involvement is a rare complication. We present a short review of the literature and describe the case of a 10-week-old boy suffering from severe diarrhoea, who presented with a swelling of the right testicle after six days of illness. He underwent surgery on suspicion of testicular torsion, whereby orchitis was diagnosed. Salmonella enteritidis was cultured from the intraoperative swab. All cultures from blood, CSF and urine remained sterile. We conclude that orchitis must be taken into consideration as an extraintestinal complication of enteric salmonellosis and as a differential diagnosis of testicular torsion. In addition, we wish to emphasize that any infant less than three months of age with suspected or proven salmonellosis, should receive early antibiotic treatment.

Genitourinary Emergencies

An awareness of pitfalls and perils in diagnosis of traumatic injuries to the genitourinary tract, and indications and contraindications for studies and instrumentation, will help diagnose these sometimes underdiagnosed injuries and help minimize morbidity. Suspicion of testicular torsion should lead to prompt urologic consultation, and priapism also should be promptly treated to preserve function. The treatment of acute urinary retention consists of prompt bladder drainage with attention to etiology and methods.

Adrenal hemorrhage versus testicular torsion ? a diagnostic dilemma in the neonate

Three boys aged 2–3 days were admitted to the Pediatric Surgical Clinic on suspicion of testicular torsion. One of the boys had a scrotal mass that on surgical exploration was shown to be a hematoma within the processus vaginalis beside a normal testis. An immediate laparotomy revealed an adrenal hemorrhage with rupture into the peritoneal cavity. Two further patients in whom a bluish discoloration of one hemiscrotum and groin had appeared postnatally were examined by ultrasound, which revealed a right-sided suprarenal mass. It is concluded that a scrotal mass or hematoma in the neonate may be the only symptom of an adrenal hemorrhage. When a scrotal mass is found an intra-abdominal hemorrhage into an inguinal hernia should be considered and if possible ultrasonographically examined before surgical exploration is performed on the suspicion of testicular torsion or tumor. Furthermore, a scrotal or inguinal hematoma should lead to an ultrasound examination of the retroperitoneal organs, especially of the adrenal glands.