From the Guidelines
Ultrasound is the best imaging modality for evaluating testicular pain, and it should be the first-line imaging test for patients presenting with acute or chronic testicular pain. This recommendation is based on the most recent and highest quality study, which suggests that ultrasound duplex Doppler scrotum and ultrasound scrotum are usually appropriate as the initial imaging for the acute onset of scrotal pain without trauma or antecedent mass in an adult or child 1. Ultrasound offers several advantages, including high-resolution images of the testicles without radiation exposure, real-time visualization of testicular blood flow using Doppler techniques, and excellent visualization of scrotal structures 1.
Key Benefits of Ultrasound
- High-resolution images without radiation exposure
- Real-time visualization of testicular blood flow using Doppler techniques
- Excellent visualization of scrotal structures
- Cost-effective and widely available
- Can effectively identify common causes of testicular pain, including:
- Testicular torsion
- Epididymitis
- Orchitis
- Hydrocele
- Varicocele
- Testicular trauma
- Testicular masses
Diagnostic Capabilities
Ultrasound can diagnose most scrotal disorders when combined with clinical history and physical examination 1. The use of color Doppler, power Doppler, and spectral Doppler ultrasound allows for the evaluation of testicular perfusion and the detection of scrotal emergencies 1. The sensitivity and specificity of color Doppler ultrasound for the detection of testicular torsion are variable, but it remains a valuable tool for diagnosing this condition 1.
Clinical Considerations
Patients should inform their provider about any recent trauma, duration of symptoms, and associated symptoms like fever or urinary problems to help guide the interpretation of ultrasound findings 1. In rare cases where ultrasound findings are inconclusive, MRI may be used as a secondary imaging option. However, ultrasound is generally preferred over CT or MRI for initial evaluation due to its accessibility, cost-effectiveness, lack of radiation, and excellent visualization of scrotal structures 1.
From the Research
Imaging Modalities for Testicular Pain
- The best imaging modality for evaluating testicular pain is not clearly defined, as different studies have shown varying results 2, 3, 4, 5, 6.
- Scrotal ultrasound is commonly used for the investigation of scrotal pain, but it can be misleading in cases of subacute testicular torsion, leading to delayed diagnosis and treatment 2.
- Color Doppler ultrasound did not help to distinguish between torsion and infection in one study 3.
- Diagnostic ultrasound can accurately diagnose many acute conditions of the scrotum, but its use should be guided by clinical judgment and physical examination findings 4, 5.
Clinical Diagnosis and Treatment
- Testicular torsion is a clinical diagnosis, and patients typically present with severe acute unilateral scrotal pain, nausea, and vomiting 5.
- Physical examination may reveal a high-riding testicle with an absent cremasteric reflex, and immediate surgical exploration is indicated if torsion is suspected 5.
- Delay in treatment may be associated with decreased fertility, or may necessitate orchiectomy, emphasizing the importance of prompt recognition and treatment 5.
Limitations of Imaging Modalities
- None of the examinations performed, including ultrasound, could reliably distinguish between acute torsion and other causes of acute scrotum 3.
- The use of imaging modalities should be guided by clinical judgment and physical examination findings, rather than relying solely on imaging results 2, 3, 4, 5, 6.