The Role of Gray Scale and Color Doppler Ultrasonography in the Diagnosis of Scrotal Lesions

Abstract

ABSTRACT

Background: Ultrasonography (US) is well suited to the study of pathological conditions of the scrotum.US provides excellent anatomic detail; when color Doppler imaging is added, testicular perfusion can be assessed.

Objectives: To evaluate the role of color Doppler ultrasonography in the diagnosis of scrotal lesions.

Methods: From February 2010 till December 2010, 130 patients with different scrotal lesions at Al-Ramadi teaching hospital were included in this descriptive case-series study, their age ranges from 6-80 years (median 39.37 years). Patients with undescended testis were excluded from the study. The patients classified into 3 groups according to their presentations, group A included patients with painless scrotal mass or swelling, group B included patients presented with infertility and group C included patients with scrotal pain. All patients were examined by gray-scale and color Doppler ultrasonography and ultrasound diagnosis was given. The final diagnosis was established by surgical exploration with or without histopathology or by clinical evaluation and follow up.

Results: Of 130 patients: 47 patients (36.1%) constitute group A, 44 patients (33.8%) constitute group B and 39 patients (30%) constitute group C. Of 47 patients in group A, 32 patients had hydrocele, 7 patients had testicular tumor and 6 patients had epididymal cysts on ultrasound examination but on final diagnosis, one case of testicular tumor is found to be tuberculous epididymo-orchitis and one case of epididymal cysts is found to be hydrocele. Also there were 2 cases of scrotal wall edema in this group. Of the 44 patients in group B, 30 patients had varicocele, 5 patients had epididymal cysts, 4 had microlithiasis, 3 had testicular atrophy and 2 had hydrocele. Of the 39 in group C, 20 patients had epididymo-orchitis, 8 had scrotal trauma, 4 had testicular torsion, 3 had hydrocele, 2 had varicocele and 2 had scrotal wall edema. Of 8 patients who had scrotal trauma, 3 had testicular rupture, 3 had testicular hematoma and 2 had scrotal wall hematoma. Of 4 patients diagnosed with testicular torsion by ultrasound, one case is found to be epididymo-orchitis. The overall sensitivity of color Doppler ultrasonography in diagnosing scrotal lesions was 98.5%

Conclusion: Gray-scale and color Doppler US is the primary imaging modality for the study of scrotal lesions. Together with the results of clinical and physical examination, the information obtained with this method is sufficient to establish diagnosis in most cases.