SONOGRAPHIC TECHNICAL ASPECTS AND IMAGING FEATURES 
IN THE EVALUATION OF ACUTE SCROTAL PATHOLOGY IN CHILDREN 
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 
ABSTRACT : 
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. 
1. INTRODUCTION 
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. 
2. MATERIALS AND METHODS 
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. 
3. RESULTS 
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. 
4. DISCUSSION 
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 
settings. 
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