Imaging of the acute scrotum: keys to a rapid diagnosis of acute scrotal disorders

Imaging of the scrotum in the setting of acute symptoms such as pain or swelling is commonly performed emergently to differentiate between patients who require immediate surgery and those that do not. Acute scrotal symptoms are generally caused by infectious, traumatic or vascular etiologies. Rapid...

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Bibliographic Details
Published in:Abdominal imaging 2020-07, Vol.45 (7), p.2063-2081
Main Authors: Sweet, David E., Feldman, Myra K., Remer, Erick M.
Format: Article
Language:English
Subjects:
CME articles
Diagnosis
Disorders
Edema
Epididymitis
Epididymo-orchitis
Etiology
Gangrene
Gastroenterology
Hematoma
Hepatology
Imaging
Infarction
Magnetic resonance imaging
Medical diagnosis
Medical imaging
Medicine
Medicine & Public Health
Neoplasms
Orchitis
Pain
Problem solving
Radiology
Scrotum
Signs and symptoms
Special Section: Male Pelvis
Surgery
Testes
Testicular cancer
Ultrasonic imaging
Ultrasound
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Summary:Imaging of the scrotum in the setting of acute symptoms such as pain or swelling is commonly performed emergently to differentiate between patients who require immediate surgery and those that do not. Acute scrotal symptoms are generally caused by infectious, traumatic or vascular etiologies. Rapid diagnosis and initiation of treatment is vital for testicular salvage in cases of acute testicular torsion, testicular rupture, and Fournier gangrene. Epididymitis, epididymo-orchitis, torsed testicular appendage, segmental testicular infarction, scrotal hematomas, testicular neoplasms, and acute idiopathic scrotal edema can have similar clinical presentations, but these conditions do not require immediate surgery. Ultrasound is the well-established first-line imaging modality for the acute scrotum. Contrast-enhanced ultrasound and magnetic resonance imaging can be useful as problem-solving tools when ultrasound studies are inconclusive or equivocal. This review describes normal scrotal anatomy and a wide range acute scrotal disorders, with emphasis on the imaging and clinical features that can minimize the risk of misdiagnosis.
ISSN:2366-004X
2366-0058
DOI:10.1007/s00261-019-02333-4