9/5/2023 0 Comments Pinpoint doppler ct![]() A high-frequency, linear-array transducer (8–15 MHz) is utilized to image the testes and scrotal contents in the longitudinal and transverse orientations. The penis should be displaced superolaterally and covered with a towel. ![]() Scrotal sonography is performed with the patient in the supine position with the scrotum supported by a folded towel placed between the thighs or a rolled towel draped over the thighs. Venous drainage is via the pampiniform plexus. The testicular artery supplies the testes, while the deferential, cremasteric, and pudendal arteries supply the vas deferens, paratesticular tissues, and scrotal wall. Appendages of the testis and epididymis are encountered variably at US and identified as subcentimeter outpouchings of tissue originating from the superior testis or epididymal head. 1) the mediastinum testis is an inferior reflection of the surrounding protective fibrous covering known as the tunica albuginea. ![]() The mediastinum testis runs along the longitudinal axis of the testis and is shown at US as a thin echogenic band at the base of the testis (Fig. The rete testis traverses the center of the testis along a partial septum or mediastinum in some patients, the rete testis can become dilated and appear as a cluster of tiny cysts. The testicular parenchyma is composed of numerous lobules, each of which consists of numerous seminiferous tubules the tubules transition into the tubuli recti and give rise to a series of dilated spaces called the rete testis. Each hemiscrotum consists of a testis and its connective tissues, an epididymis, and a portion of the spermatic cord on average, a normal adult testis measures approximately 5 × 3 × 2 cm and shows a nearly homogenous, intermediate echogenicity at grayscale US evaluation. The scrotum is divided centrally by the median raphe. The scrotum is the protuberance of skin, muscle, and connective tissue covering the testes and epididymes. In this article, we provide a pictorial summary of some of the more common etiologies resulting in acute scrotal pain. Finally, the lack of ionizing radiation makes US a safe, effective means of examining the scrotum. In addition to its ability to often allow a specific diagnosis, another strength of scrotal US is its speed and portability. The addition of gray scale ultrasound can be used to help determine if a testis has undergone necrosis and is no longer salvageable. The use of color and duplex Doppler ultrasound is unsurpassed in differentiating several acute scrotal conditions, such as epididymo-orchitis, torsion, and infarction. The performance of scrotal US in the trauma setting is emphasized as the amount of soft tissue swelling, ecchymosis, and hematoma does not always correlate with the degree of testicular injury. High-resolution imaging of the scrotum is especially important for evaluating small scrotal structures which were previously difficult to differentiate with earlier platforms an example is the tunic albuginea, where early detection of a focal defect can allow diagnosis of testicular rupture and will facilitate prompt surgical intervention resulting in improved testis salvage rates. Additionally, a thorough US examination should also include evaluation of nearby structures in the proper clinical setting examples include scanning of the perineum and base of the penis in cases of suspected infection/abscess resulting in referred pain to the scrotum, and scanning of the inguinal canal in cases of suspected hernia. Newer US platforms and linear-array transducers have evolved to allow high-resolution imaging of the scrotum and its contents. Therefore, scrotal ultrasound has emerged to play a pivotal role in the evaluation of the patient presenting with acute scrotal pain. ![]() ![]() Additionally, the laboratory and physical examination findings in such conditions may overlap this, coupled with potential patient guarding and lack of cooperativity, may result in a limited, non-specific physical examination. Acute scrotal conditions due to traumatic, infectious, vascular, or neoplastic etiologies can all present with pain as the initial complaint. The evaluation of acute scrotal pain can be challenging for the clinician initially examining and triaging the patient. ![]()
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