Ronald B. Keys, JD, PhD
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Free Initial Consultation - Call Now (954) 448-1515 Scrotal Ultrasound; Getting The Picture Now By Ronald B. Keys, JD, PhD Definition Scrotal ultrasound is an imaging technique used for the diagnosis of suspected abnormalities of the scrotum. It uses harmless, high-frequency sound waves to form an image. The sound waves are reflected by scrotal tissue to form a picture of internal structures. It is not invasive and involves no radiation. This is consistent with the very first teaching in clinical medicine....PRIMUM NON NOCERE (LATIN), for FIRST, DO NO HARM. Other common techniques for exploring inside of the body without surgery include MRI (magnetic resonance imaging)and X-rays but whose scans require the patient to lay still for minutes or raise the issue of harmful radiation. In urology, with use of invasive deferentography, strictures or obstructions may be present as a post-examination consequence contrasted with ultrasound which may provide clear information without risk. Ultrasound may guide biopsy, too. Scrotal injuries can cause lesions that vary widely in severity, semiotics, and treatment. Scrotal ultrsound is an accurate tool in the hands of an experienced radiologist, enabling a clear, accurate diagnosis to be reached reasonably fast in pressing circumstances. Color flow and duplex Doppler imaging, in particular, are highly useful techniques not only for assessing testicular viability and perfusion but also for evaluating associated vascular injuries such as pseudoaneurysms. A thorough familiarity with the US findings of scrotal trauma helps facilitate appropriate management, also. If the worth of an act lays in its timing, then, the timely diagnosis of rupture, based on a US finding of discontinuity of the echogenic tunica albuginea, is critical because emergent surgery may result in salvage of the testis in 80%-90% of rupture cases. Timing sometimes is everything in differential diagnosis and outcome, later post-surgical range of function, quality of life of a patient and is an important, major definitional feature. Availability As ultrasound machines become compact and their image quality more precise, this body-imaging technology is being carried to rural US Hospitals and developing countries. It is not just available to hospitals with reliable power supplies and space for bulky equipment. It is becoming a field tool as portable ultrasound. As a compact machine that may be the size of a laptop computer, it is becoming popular with urologists and other doctors outside of the traditional areas of radiology, cardiology and prenatal care. Purpose Ultrasound of the scrotum is the primary imaging method used to evaluate disorders of the testicles and surrounding tissues. It is used when a patient has acute pain in the scrotum. Some of the problems for which the use of scrotal ultrasound is valuable include an absent or undescended testicle, an inflammation problem, testicular torsion, a fluid collection, abnormal blood vessels, or a mass (lump or tumor). A sudden onset of pain in the scrotum is considered a serious problem, as delay in diagnosis and treatment can lead to loss of function. Epididymitis is the most common cause of this type of pain. Epididymitis is an inflammation of the epididymis, a tubular structure that transports sperm from the testes. It is most often caused by bacterial infection, but may occur after injury, or arise from an unknown cause. Epididymitis is treatable with antibiotics, which usually resolves pain quickly. Left untreated, this condition can lead to abscess formation or loss of blood supply to the testicle. Testicular torsion is the twisting of the spermatic cord that contains the blood vessels which supply the testicles. It is caused by abnormally loose attachments of tissues that are formed during fetal development. Torsion can be complete, incomplete, or intermittent. Spontaneous detorsion, or untwisting, can occur, making diagnosis difficult. Testicular torsion arises most commonly during adolescence, and is acutely painful. Scrotal ultrasound is used to distinguish this condition from inflammatory problems, such as epididymitis. Testicular torsion is a surgical emergency; it should be operated on as soon as possible to avoid permanent damage to the testes. A scrotal sac with an absent testicle may be the result of a congenital anomaly (an abnormality present at birth), where a testicle fails to develop. More often, it is due to an undescended testicle. In the fetus, the testicles normally develop just outside the abdomen and descend into the scrotum during the seventh month. Approximately 3% of full-term baby boys have undescended testicles. It is important to distinguish between an undescended testicle and an absent testicle, as an undescended testicle has a very high probability of developing cancer. Ultrasound can be used to locate and evaluate masses in the scrotum. Most masses within the testicle are malignant or cancerous, and most outside the testicle are benign. Primary cancer of the testicles is the most common malignancy in men between the ages of 15-35. Fluid collections and abnormalities of the blood vessels in the scrotum may appear to the physician as masses and need evaluation by ultrasound. A hydrocele, the most common cause of painless scrotal swelling, is a collection of fluid between two layers of tissue surrounding the testicle. An abnormal enlargement of the veins which drain the testicles is called a varicocele. It can cause discomfort and swelling, which can be examined by touch (palpated). Varicocele is a common cause of male infertility. Precautions Clear scrotal ultrasound images are difficult to obtain if a patient is unable to remain still. Also, it's effectiveness depends upon operators knowing precisely how to position patients and where to place the imaging probes to reveal the best views. Information developed from scrotal ultrasound are operator-dependent and must be supported by the clinical history and physical examination of the patient. Findings are critical as an important medico-legal support when the necessity of surgical exploration is excluded. However, if there is clinical suspicion of testicular torsion, surgical exploration may be still recommended even with an apparently normal scrotal ultrasound finding. To doctors, imaging quality is the key. The newer, compact units can now produce images comparable to those of the higher end console units. Now a gold standard, this is becoming an indispensible imaging method for clinical assessment of acute scrotum. Description The patient lies on his back on an examining table. The technologist will usually take a history of the problem, then gently palpate the scrotum. A rolled towel is placed between the patient's legs to support the scrotum. The penis is lifted up onto the abdomen and covered. A gel that enhances sound transmission is put directly on the scrotum. The technologist then gently places a transducer (an electronic imaging device) against the skin. It is moved over the area creating images from reflected sound waves, which appear on a monitor screen. There is no discomfort from the study itself. However, if the scrotum is very tender, even the slight pressure involved may be painful. Normal results A normal study would reveal testicles of normal size and shape, with no masses. Abnormal results An abnormal result of an ultrasound of the scrotum may reveal an absent or undescended testicle, an inflammation problem, testicular torsion, a fluid collection, abnormal blood vessels, or a mass. Key Terms Hydrocele A collection of fluid between two layers of tissue surrounding the testicle; the most common cause of painless scrotal swelling. Varicocele An abnormal enlargement of the veins which drain the testicles. For Your Information Free Initial Consultation - Call Now (954) 448-1515 RONALD B. KEYS, JD, PhD CLINICAL & OPERATIONS DIRECTOR Ronald B. Keys, JD, PhD 4047 Peters Road Plantation, Florida, 33317-4537 USA 954-448-1515 primary email: rkeysphd@brainlink.com secondary email: rkeysphd@gmail.com secondary email: rkeysphd@yahoo.com by pre-arrangements for voice/text chat: Mostly, Dr. Keys works as a Consulting PhD Doctor, usually from a distance, with and through a proper local anchor physician to order blood work. Advanced treatment protocols may develop from the advanced blood chemistries he requests. If you have no local doctor, Dr. Keys finds one through an affiliate physician network. His work is global, oftetimes involving patients from other countries as well as all over the continental USA. There are many tests and treatments to help people; Oftentimes, anchor physicians are not familiar or comfortable with them. Dr. Keys teaches and helps to direct individual patients AND their physicians with laboratory-work for these treatment options. This is measured work and clinical biochemistry. Opinion evidence standards are not employed here since this is a measured and laboratory-based or empirical study of the patient. Numbers are sought from the results of these tests that, usually, "...jump up and grab you..." that dictate what is needed and how much. Patient-advocacy is frequently involved to get advanced and necessary clinical biochemistries ordered and to help interpret them in filed reports..Chat room capabilities in voice or text, besides email, may be employed. This may include conference calls online. In a perfect world, if your physician knew everything, people like Dr. Keys would not exist. Physicians themselves are caught frequently in the traps of their own standards of care that may be very limited in many cases. Methods used by Dr. Keys are rational, scientific and disciplined. DISCLAIMER: Ronald B. Keys, JD, PhD is not a physican. He acts here, when hired, only as a consulting PhD doctor. Any information offered on this site is intended for prevention and education. It is the responsibility of your anchor doctor or chosen physician to diagnose and treat diseases through their medical licenses. By using this web site you agree that you will seek professional medical advice from your doctor before using any of the information presented on this web site. All tests are ordered through your physician, only, and not Dr. Keys. Most jurisdictions require that an attending physician is required by law to take patient and family history, conduct a physical examination of the patient and to order tests appropriate and necessary. As an online consultant, he cannot do these things required together, as a whole, as a practice of medicine. Any emergencies should only be handled in a hospital emergency room or by your physician. |