Testicular Ultrasound Pearls
Leave a commentOctober 21, 2015 by dailybolusoflr
By: Casey Wilson , MD
On behalf of the Ultrasound FAST
Pearls
- Keep patient supine and comfortable (analgesia is key!)
- Place towel underneath scrotum to immobilize and elevate
- Use high frequency (6-14 MHz) linear probe
- Generous amount of warmed (if possible) gel to prevent cremasteric reflex
- Start with unaffected side
- Obtain transverse and longitudinal views
- Normal appearance seen in Figure 1
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http://www.ultrasound-images.com |
Normal Testes
- Have a homogenous echogenicity (~ liver)
- Wall thickness 2-8 mm
- Normal size ~ 5 x 3 x 2 cm
- Obtain the “Spectacle View” – seen in Figure 2
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http://www.ultrasound-images.com |
Testicular Torsion
- Key to diagnosis is a difference in flow
- Apply color flow when you obtain the “spectacle view”
- Takes at least four hours to appear hypo-echoic and edematous
- When you see a flow differential, it’s important to keep in mind which side is hurting! If the affected side has decreased flow, think torsion. If the affected side has increased flow, think epididymitis.
- If the patient’s right testes is painful in the image below (Figure 3), you better be calling urology!
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http://www.ultrasound-images.com |
Color Duplex Doppler
- Color Duplex Doppler is 96-100% sensitive and 84-95% specific for diagnosing testicular torsion.
- A negative ultrasound is highly predictive of the ABSENCE of torsion at the time of exam.
- Place the probe transversely at the mediastinum testis to assess vascular integrity
- The image below (Figure 4) demonstrates normal arterial flow.
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http://www.sonosite.com/clinical-media |
References
- Adhikari, S. Small Parts: Testicular Ultrasound. www.Sonoguide.com
- Blaivas M, Sierzenski P, Lambert M. Emergency evaluation of patients presenting with acute scrotum using bedside ultrasonography. Acad Emerg Med. 2001; 8(1):90-3.
- Cassar S, Bhatt S, Paltiel H, et al. Role of spectral Doppler sonography in the evaluation of partial testicular torsion. J Ultrasound Med. 2008;27(11):1629-38