Swollen, Painful Privates

 

A 13 year old male with no PMH presented with right lower abdominal/inguinal/testicular pain that started that morning. He reported nausea and had 2 episodes of NBNB emesis.

You obtain the following images and clips below:

 

Left Testicle:

Right Testicle:

 

ANSWER:

Testicular Torsion.

Immediately after POCUS, urology was called as the patient was on his way to his ultrasound by radiology. Urology evaluated the patient in radiology, where the radiology study confirmed torsion, and he was taken directly to the OR from radiology. He underwent successful detorsion and orchiopexy and was discharged home.

The most common causes of testicular pain in children include: testicular torsion, torsion of the appendix testis  and epididymitis. Although torsion can be a clinical diagnosis, ultrasound is the diagnostic imaging study of choice for confirmation. It has a sensitivity of 69-100% and specificity of 77-100%. Although POCUS can aid in the diagnosis a confirmatory study should always be performed and POCUS should not delay confirmation.

How to perform POCUS testicular US

Place the patient supine

Expose and elevate the scrotum using a folded towel between the patients thighs.

Use the high frequency linear probe and scan the scrotum in 2 planes (transverse and long).

Use color and power doppler to evaluate for flow.

Compare the testicles.

 

  

 

Want to learn more?!

https://www.youtube.com/watch?v=IQ5pUWIu6mI

  • Kadish HA, Bolte RG. A retrospective review of pediatric patients with epididymitis, testicular torsion, and torsion of testicular appendages. Pediatrics 1998; 102:73.
  • Lam WW, Yap TL, Jacobsen AS, Teo HJ. Colour Doppler ultrasonography replacing surgical exploration for acute scrotum: myth or reality? Pediatr Radiol 2005; 35:597.
  • Paltiel HJ, Connolly LP, Atala A, et al. Acute scrotal symptoms in boys with an indeterminate clinical presentation: comparison of color Doppler sonography and scintigraphy. Radiology 1998; 207:223.
  • Baker LA, Sigman D, Mathews RI, et al. An analysis of clinical outcomes using color doppler testicular ultrasound for testicular torsion. Pediatrics 2000; 105:604.
  • Yazbeck S, Patriquin HB. Accuracy of Doppler sonography in the evaluation of acute conditions of the scrotum in children. J Pediatr Surg 1994; 29:1270.
  • Kass EJ, Stone KT, Cacciarelli AA, Mitchell B. Do all children with an acute scrotum require exploration? J Urol 1993; 150:667.
  • Nussbaum Blask AR, Bulas D, Shalaby-Rana E, et al. Color Doppler sonography and scintigraphy of the testis: a prospective, comparative analysis in children with acute scrotal pain. Pediatr Emerg Care 2002; 18:67.
Laurie Malia

Laurie Malia

Assistant Professor of Emergency Medicine and Pediatrics,Pediatric Emergency Medicine Ultrasound Fellow at Morgan Stanley Children's Hospital /Columbia University Medical Center Department of Emergency Medicine
PEM doc; POCUS; Pediatrics; Healthcare equality
Laurie Malia

Latest posts by Laurie Malia (see all)

Laurie Malia

Laurie Malia

PEM doc; POCUS; Pediatrics; Healthcare equality