Scrotal Pain (Acute)

By Charbel on Mar 6, 2011 | In Health, REPRODUCTIVE

Male

Scrotal Pain (Acute)
Common Causes

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Testicular torsion (usually in patients younger than age 20; characterized by more acute onset)

Acute epididymo-orchitis (most common after age 20; more gradual onset, often with pyuria)

Vasculitis (e.g., Henoch-Schönlein purpura in children, polyarteritis nodosa in adults)

Trauma

Strangulated, incarcerated hernia

Testicular cancer (10% of testicular cancers present with acute pain)
Approach to Diagnostic Imaging

1.
Ultrasound with color Doppler

Torsion: decreased or absent flow on the symptomatic side

Epididymo-orchitis: diffuse increase in blood flow on the affected side

2.
Radionuclide flow study

Torsion: a rounded cold area surrounded by a rim of increased radionuclide activity reflecting hyperemia (doughnut sign)

Epididymo-orchitis: a generalized increase in vascular flow to the affected side
Caveat: The choice of imaging technique is made on an individualized basis. To rule out torsion, the general preferences are to use US in adults and radionuclide studies in children

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