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Close-range imaging, long-range vision

Katsimba D.**, Tzouveleki M.*, Miliou Th.**, Christopoulos S.**
* Department of Pharmacology Medical Faculty, The Aristotle University of Thessaloniki, Greece
** Department of Radiology, General Hospital of Thessaloniki, Greece, *G. Gennimatas"
WG V/3
KEY WORDS: Medical imaging, Sonar, Doppler
Evolutions in technical aspects in ultrasound and color Doppler sonography have resulted in increased partial and high contrast reso-
lution. Thus, the two methods of investigation exhibit high diagnostic accuracy in many pathologic conditions.
Especially in children's acute scrotal pathology, high resolution ultrasound combined with color Doppler sonography is the method
of choice, consisting an accurate, safe and time — saving imaging modality, thus, in many cases, setting an early diagnosis, which is a
crucial factor for achieving gonadal salvage.
We present the sonographic findings of acute scrotal abnormalities in children, according solely to which, accurate diagnosis and dif-
ferential diagnosis can be made.
Acute scrotal pain is one of the most common pediatric
emergency problems. It may be the manifestation of
several pathologic conditions in this age group. In most
cases, clinical diagnosis cannot be definite and
differential diagnosis is needed. Risk of gonadal viability
should, in all cases, be quickly recognized in order to
determine whether immediate surgery is required.
Technological advances in ultrasonography resulting in
high resolution and sensitivity have offered the ability to
experienced radiologists to evaluate superficial parts,
such as the scrotum, allowing early, accurate and safe
diagnosis in acute scrotal pathology.
During the last two years, 229 boys between 2 months
and 14 years of age, with acute painful were sonographi-
cally evaluated.
In all cases, the painful side was examined in comparison
to the opposite normal one, with a high resolution linear
high frequency (7-9 MHz) transducer. Color Doppler so-
nography with settings optimized to detect slow flow
within testicular vessels of the normal side was also per-
formed in all cases.
We diagnosed epididymitis in 77 cases, epididymo-
orchitis in 18, testicular torsion in 21, torsion of appendix
in 48, hydrocele in 37, scrotal hernia in 12 (incarcerated
in 4), trauma in 12, and idiopathic edema in 4 cases. Sur-
gical findings or follow up confirmed the sonographic di-
agnosis in all cases but 3. In these 3 cases, torsion of the
appendix was missinterpretated as epididymitis, because
edema and hyperhaemia of the epididymal head was the
only finding.
Pediatric acute scrotal pain is a potential surgical emer-
gency, as testicular or, less commonly, intestinal viabil-
ity is considered to be at risk in all cases. Common
causes include testicular torsion, torsion of appendages
and acute epididymitis or epididymo-orchitis. Less com-
mon causes include acute hydrocele, scrotal hernia,
trauma, idiopathic scrotal edema and infarction.
Technological advances have established ultrasound (US)
as the modality of choice in the evaluation of acute scro-
tum, allowing early and accurate diagnosis. Although
gray-scale images may be diagnostic, color Doppler US
proves to be extremely helpful in most cases.
High spatial resolution, high contrast resolution and high
color Doppler sensitivity result in US images of high di-
agnostic value. High spatial resolution offers the ability
to distinguish small structures or focal lesions, whereas,
high contrast resolution offers the ability to distinguish
among different types of tissue. Such images are obtained
by using: a) a linear high resolution, high frequency (7-13
MHz) transducer and b) appropriate focusing and image
making techniques which are achieved by digital control.
Color Doppler parameters must be optimized to detect
low velocity and low volume flow in the small testicular
vessels. High color Doppler sensitivity is obtained by
low velocity scale, low wall filters and high gray-scale