Diagnostic ultrasound ( PDFDrive )

1892 PART V Pediatric Sonography
A B C
FIG. 54.33 Cystic Dysplasia of Testis. (A) Sagittal sonogram and (B) color Doppler sonography show multiple tiny cysts in the testicle.
(C) Pathologic specimen shows tiny cysts. (Courtesy of Janet Strife, MD, Cincinnati Children’s Hospital.)
purpura, scrotal fat necrosis, familial Mediterranean fever, and
secondary scrotal involvement from abdominal pathology. 102-106
It is oten impossible clinically to diferentiate between the conditions
that require conservative medical treatment and those
that demand immediate surgery. 107 However, the combination of
gray-scale and color Doppler sonography provides information
about morphology and testicular perfusion. 108-111
Acute Scrotal Pain or Swelling
FIG. 54.34 Tubular Ectasia of the Rete Testis. This 9-year-old boy
had left scrotal pain. Sagittal sonogram demonstrates a focal cluster of
tiny, oval cysts (arrows) in the symptomatic area.
defect may result from an embryologic defect preventing fusion
between the rete testis tubule (arising from the gonadal blastema)
and eferent ductules (arising from the mesonephros). Several
reported cases in children were associated with ipsilateral renal
agenesis, multicystic dysplastic kidney, or renal dysplasia. 101,102
he appearance in the scrotum is similar to the incidentally
noted condition of tubular ectasia of the rete testis described in
adults, which probably represents an acquired condition secondary
to prior inlammation or trauma 102,103 (Fig. 54.34). he lack of
color low within these cystic structures distinguishes tubular
ectasia from intratesticular varicocele, which can have a similar
gray-scale appearance but demonstrates venous low on color
Doppler imaging. 104 his condition may mimic a cystic neoplasm
such as teratoma. If illed with mucoid material or debris instead
of anechoic luid, the cysts may mimic a solid mass.
ACUTE SCROTAL PAIN OR SWELLING
he most common causes of acute pain and swelling in the
pediatric scrotum include testicular torsion, epididymitis
with or without orchitis, torsion of the testicular appendages,
testicular trauma, acute hydrocele, and incarcerated hernia. Less
common causes are idiopathic scrotal edema, Henoch-Schönlein
COMMON
Testicular torsion
Epididymitis with and without orchitis
Torsion of testicular appendages
Testicular trauma
Acute hydrocele
Incarcerated hernia
UNCOMMON
Idiopathic scrotal edema
Henoch-Schönlein purpura
Scrotal fat necrosis
Familial Mediterranean fever
Abdominal pathology
Testicular torsion and epididymitis (with or without orchitis)
are the two most frequently encountered causes of the acute
scrotum in the pediatric population. High-resolution ultrasound
with color Doppler imaging is the method preferred for distinguishing
between these two entities. 108-117 his is crucial because
testicular torsion is treated surgically and epididymitis with or
without orchitis is treated medically. To conirm the diagnosis
of testicular torsion unequivocally, the clinician must demonstrate
absence of low in the painful testis and normal low in the
asymptomatic normal testis, 89 keeping in mind that the presence
of low in the painful testis does not exclude torsion. In the
patient with incomplete or partial spermatic cord torsion (twist
of ≤360 degrees), normal arterial low may be demonstrated,
although it is usually quantitatively diminished compared with
the asymptomatic contralateral testis. 115,117
Torsion of the spermatic cord is found in 14% to 31% of
children and adolescents with an acute scrotum. Testicular torsion
results when the testis and spermatic cord twist one or more