Subacute scrotal pain: evaluation of torsion versus epididymitis with MR imaging

Article Abstract:

Scrotal pain is a symptom of a number of diseases and abnormalities. Two of the most common causes of this symptom are epididymitis and spermatic cord torsion. Epididymitis is an inflammation of the epididymis, the structure containing the tube that originates in the testis and carries sperm. Spermatic cord torsion is a twisting of the spermatic cord, which supplies the testes with blood vessels and nerves. These two abnormalities are difficult to differentiate from each other with noninvasive techniques (which do not involve entering the body). Ultrasonography (US) and scintigraphy are two noninvasive imaging techniques that have been used for helping to differentiate these disorders, but a more accurate method is needed. A major difference between the two disorders is that epididymitis causes an increased vascularity (number of blood vessels) to the area, while torsion blocks blood flow. Magnetic resonance (MR) imaging is a noninvasive technique that can visualize blood vessels. It may be able to show vascularity as well as twisting of a vessel. This study evaluated using MR to differentiate between torsion and epididymitis. This technique was performed on 11 patients complaining of scrotal pain. Confirmation of the diagnosis was available by surgery in five cases and clinically in four. Results showed that MR was able to correctly identify the cause of the scrotal pain in all the cases. MR detected the increased vascularity in all the epididymitis cases and did not detect any such increases in the torsion cases. Torsion was directly evident in five of the six cases as either a knot or a whirlpool pattern. Although the size of this study was small, it indicates that MR imaging may be highly effective in differentiating between epididymitis and spermatic cord torsion. (Consumer Summary produced by Reliance Medical Information, Inc.)

Magnetic resonance imaging, Epididymitis

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True hermaphroditism: sonographic demonstration of ovotestes

Article Abstract:

True hermaphroditism is a condition characterized by the presence of both major sex organs, the ovary and the testis, or by the present of the tissues of both (ovotestis). In some patients, the external sex organs are affected; in others, they appear normal. In the latter case, those with male external genitalia usually develop breasts at puberty and histologic examination is needed to confirm ovotestis. Until this time, the hermaphroditism may be undetected. This study reports the use of ultrasound (US) to establish ovotestis. US uses high-frequency sound waves to produce images of tissues and organs. A 15-year-old boy reported scrotal pain and swelling. His external sex organs appeared normal for his age, but his nipples were enlarged and one testicle was smaller than normal and the other was larger than normal. Elevated levels of luteinizing hormone and follicle-stimulating hormone were found, indicating his testes were not functioning. When US was performed on the testes, results showed abnormalities consisting of ovoid-shaped testes with a heterogenous appearance, but no conclusions were made. Surgery was performed and examination of testicular tissues revealed the presence of ovarian tissue. The ovarian tissue was removed, but four months later the patient returned with testicular pain and swelling. US showed the testes contained ovarian tissues and cysts. These were also surgically removed. The patient was given testosterone supplements and has remained without further symptoms. It is concluded that US scanning can detect true hermaphroditism in adolescent males. The testes in these males appear ovoid and heterogenous on US. (Consumer Summary produced by Reliance Medical Information, Inc.)

Hermaphroditism

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Intrauterine spermatic cord torsion in the newborn: sonographic and pathologic correlation

Article Abstract:

Spermatic cord torsion (twisting) occurs sometimes in the newborn male. It appears as a mass in the scrotum. It has never been characterized using sonography, an imaging process using ultrasound. This study examined sonographic findings in five cases of spermatic cord torsion that had been diagnosed surgically. These findings were then compared with pathologic findings. The results of sonography showed enlarged and globular testes corresponding to abnormalities found by touch (palpation). Four of the five infants showed heterogeneous structure of the functional part of the testis (testicular parenchyma). Hypoechoic regions (empty regions on the sonogram) were seen in four of the five patients. Skin thickening and hydrocele (serous tumors of the testis) were seen in all five patients. Scintigraphs (photographs of outlines of organs using radioactive substances) revealed the torsion in two patients and showed ambiguous results in the other three. Surgery was performed after the sonography and confirmed the diagnosis of spermatic cord torsion. Pathologic findings showed complete hemorrhage in the testis. Other pathologic findings of hemorrhage, calcification, and tissue death (necrosis) corresponded well with sonographic findings. Although spermatic cord torsion is relatively rare, these results indicate that it should be considered a possibility when a neonatal sonogram exhibits a scrotal mass. This indication in addition to skin thickening and hydrocele are predictors of this problem. Early detection can lead to early surgical treatment and possibly lessen the damage caused by the torsion. (Consumer Summary produced by Reliance Medical Information, Inc.)

Birth defects, Spermatic cord

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