sodium-pertechnetate-tc-99m and Epididymitis

Topics: Acute Disease; Adult; Age Factors; Analgesics; Epididymitis; Genital Diseases, Male; Gonorrhea; Humans; Male; Radionuclide Imaging; Scrotum; Sodium Pertechnetate Tc 99m; Spermatic Cord Torsion; Technetium; Testicular Neoplasms; Testis; Tetracycline; Trachoma; Ultrasonography

Torsion of the testis is a urologic emergency that requires early diagnosis and prompt surgical treatment for testicular survival. However, the early differential diagnosis of acute testicular torsion from epididymitis or orchitis is often difficult. The aim of this retrospective study was to evaluate and compare the value of Tc-99m pertechnetate radionuclide imaging and ultrasonography in the differentiation of acute testicular torsion and inflammatory testicular diseases.. Twenty patients (age range, 5 to 38 years) with possible acute testicular torsion from July 2000 to July 2001 were enrolled in this study. Ultrasonography was performed in all patients in the emergency room. Within 3 hours of ultrasonography, radionuclide imaging was also performed after intravenous injection of 5 to 15 mCi Tc-99m pertechnetate in the forearms. All of the patients with clinically suspected acute testicular torsion underwent surgery. The surgical findings and pathologic reports of these patients were reviewed and definite diagnoses were established. None of the other patients had surgery and were followed clinically for at least 1 month after ultrasonography and radionuclide imaging.. Four patients with testicular torsion, 13 patients with inflammatory testicular disease, and three healthy persons had a final surgical and pathologic diagnosis or clinical follow-up, and all were accurately diagnosed by Tc-99m pertechnetate radionuclide imaging. In contrast, ultrasonography was less accurate in the diagnosis and differentiation of acute testicular torsion from inflammation. Only 1 of 4 patients with testicular torsion, 5 of 13 patients with inflammatory testicular disease, and 2 of 3 healthy persons were diagnosed by ultrasonography.. The results indicate that Tc-99m pertechnetate radionuclide imaging is a more useful and accurate imaging method than ultrasonography in the detection and differentiation of acute testicular torsion from inflammatory testicular disease in patients with acute scrotal pain.

Topics: Acute Disease; Adolescent; Adult; Child; Child, Preschool; Diagnosis, Differential; Epididymitis; Follow-Up Studies; Humans; Male; Orchitis; Radionuclide Imaging; Radiopharmaceuticals; Retrospective Studies; Sodium Pertechnetate Tc 99m; Spermatic Cord Torsion; Ultrasonography

Topics: Adolescent; Diagnosis, Differential; Epididymitis; Humans; Male; Radionuclide Imaging; Radiopharmaceuticals; Sodium Pertechnetate Tc 99m; Spermatic Cord Torsion; Testis

To evaluate the effectiveness of testicular scintigraphy in differentiating testicular torsion from acute epididymitis.. 14 out of 17 patients previously screened by urologist were referred for testicular scintigraphy. Preoperative diagnosis was made based on dynamic and static image findings. Close follow-up was done and final diagnosis was confirmed on the basis of operative findings or relief of symptoms after conservative management.. Eight of the nine patients with a photopenic area in the hemiscrotum were confirmed surgically as having testicular torsion. One patient was diagnosed as having an inflammatory process. Relief from symptoms after conservative management was noted in three patients with increased activity on the affected side and in two others whose uptake patterns were not different from the unaffected side.. Testicular scintigraphy is effective in differentiating testicular torsion from acute inflammation when all other scrotal anomalies have been eliminated.

Topics: Acute Disease; Adolescent; Adult; Child; Diagnosis, Differential; Epididymitis; Humans; Male; Radionuclide Imaging; Sodium Pertechnetate Tc 99m; Spermatic Cord Torsion

Topics: Adult; Diagnosis, Differential; Epididymitis; Humans; Male; Radionuclide Imaging; Scrotum; Sodium Pertechnetate Tc 99m; Spermatic Cord Torsion; Testicular Hydrocele

In a retrospective study of patients with acute scrotal pain presenting to the hospitals of Southern Illinois University School of Medicine from January 1982 until September 1987, determination was made of the appropriate use of testicular scan for definitive diagnosis. Though the testicular scan is a highly sensitive and specific examination in the identification of testicular torsion, we believe its routine use in clinical practice is limited. Appropriate utilization of the examination requires its use in high-risk groups with equivocal physical findings or in patients with unusual presentations of age, anatomy, or neurologic deficit. The scan if used for routine screening of the acute scrotum would result in needless delays and unjustifiable expense when it is mandatory that the treatment be immediate surgical exploration.

Topics: Acute Disease; Adult; Child; Epididymitis; Humans; Male; Radionuclide Imaging; Retrospective Studies; Scrotum; Sodium Pertechnetate Tc 99m; Spermatic Cord Torsion; Testis; Time Factors

Topics: Adolescent; Diagnosis, Differential; Epididymitis; Humans; Male; Radionuclide Imaging; Sodium Pertechnetate Tc 99m; Spermatic Cord Torsion

Correct diagnosis of subtorsion of the spermatic cord was established in 9 patients by gamma-camera scintigraphy with 99mTc sodium pertechnate. The tentative out-patient diagnosis in 8 patients was acute orchiepididymitis and 2 were suspected of having torsion of the spermatic cord. The scintigraphic image of spermatic cord subtorsion is very characteristic and allows precise diagnosis. At the site of the testis there is some degree of activity--the smaller the degree of torsion the higher the activity is. Around the testis there is a ring-shaped bank of increased activity. In torsion of the spermatic cord (torsion greater than 360 degrees) a cold zone is visualized at the site of the testis, surrounded by a ring of increased activity. In acute orchiepididymitis the testis is seen enlarged with evidence of increased capillary tissue blood flow; on later scintigrams the activity in the testis is strongly increased. Gamma-camera scintigraphy is a quick, exact and noninvasive method, which contributes much to estbich precise diagnosis in cases of acute scrotum. The scintigraphic image of subtorsion and torsion of the spermatic cord is very characteristic and explicit, allowing to distinguish this disease from acute orchiepididymitis. This in turn is of major importance for successful emergency operation to preserve the testis.

Topics: Adolescent; Adult; Emergencies; Epididymitis; Humans; Male; Orchitis; Radionuclide Imaging; Sodium Pertechnetate Tc 99m; Spermatic Cord; Spermatic Cord Torsion

A false-positive scan for testicular torsion can be obtained in a scrotal scan when either a hernia or hydrocele overlies the testicle. The case of a patient in whom a false-positive scan was avoided by the use of a caudal view is reported.

Topics: Adult; Diagnosis, Differential; Epididymitis; False Positive Reactions; Humans; Male; Radionuclide Imaging; Sodium Pertechnetate Tc 99m; Spermatic Cord Torsion; Spermatocele

Fifty-four patients complaining of acute painful scrotal swelling were submitted to urgent radionuclide scrotal imaging. Clinical and surgical findings were compared with the results of radionuclide studies. Radionuclear scrotal imaging is an easy rapid none invasive investigation with high accuracy in inflammatory disease of the scrotal content. Two falsely negative examinations confirmed by surgical exploration, however, warn against relying on this method as a single test in the diagnosis of acute testicular torsion.

Topics: Epididymitis; Humans; Male; Radionuclide Imaging; Scrotum; Sodium Pertechnetate Tc 99m; Spermatic Cord Torsion

A case of acute epididymitis evolved into testicular infarction. Scrotal scintigraphy identified the initial epididymitis and subsequent evolution into infarction.

Topics: Acute Disease; Adolescent; Epididymitis; Humans; Infarction; Male; Radionuclide Imaging; Sodium Pertechnetate Tc 99m; Testis

The efficacy and merit of testicular imaging, utilizing Tc-99m pertechnetate, were studied prospectively in a group of patients who presented with acute onset of scrotal pain. Consecutive admissions were studied. All were managed according to the likelihood of the problem being testicular torsion, which was determined from the clinical history, physical examination and the routine laboratory data. The final diagnostic outcome, whether by surgical exploration or clinical progress with conservative treatment, is collated with the preoperative scintigraphic interpretations, made with respect to predefined criteria. Analysis of the pretreatment images obtained in 57 patients shows that the radionuclide study is highly reliable in cases of testicular torsion and epididymo-orchitis. It appears to be much less dependable, however, in the other acute scrotal conditions. Torsions that are intermittent in nature or corrected manually apparently can have variable presentations. Certain difficulties and potential pitfalls encountered in interpreting the scintigraphic studies are discussed.

Topics: Abscess; Acute Disease; Adolescent; Adult; Aged; Child; Epididymitis; Genital Diseases, Male; Humans; Male; Middle Aged; Orchitis; Pain; Radionuclide Imaging; Scrotum; Sodium Pertechnetate Tc 99m; Spermatic Cord Torsion; Testicular Hydrocele

Testicular scanning with technetium-99m sodium pertechnetate was performed on 152 patients with a variety of intrascrotal lesions. Scrotal images were obtained serially in the perfusion, tissue phase, illustrating the features of each phase in various clinical conditions. The relationship of scrotal imaging to the overall clinical presentation and evaluation of these patients is emphasized in testicular torsion of the testicular appendix, epididymitis, abscess, trauma, tumor, spermatocele, and varicocele. Technical problems of the scanning are also discussed.. Testicular scanning with technetium-99m sodium pertechnetate was performed on 152 patients with various intrascrotal lesions. Prior to scanning, the patients were given an oral dose of 200 mg KD104 to control thyroid gland's exposure to radiation. Scrotal images were obtained 16 times with 2 seconds' interval in the perfusion phase and twice with 5 minutes' interval in the tissue phase. The rate of correct diagnosis by scrotal images were 100% for testicular torsion and acute epididymitis, significantly high for scrotal abscess and varicocele, 40-50% for testicular tumor, and low in the cases of hydrocele, testicular trauma and spermatocele. In testicular torsion, a rounded cold area and a halo of dartos perfusion were observed. Scrotal imaging proved to be useful for post-operative diagnosis of testicular vascularity also. In "missed" testicular torsion, scrotal scan showed a "halo sign" in the tissue phase due to intensified vascularity in the dartos, and a "nubbin sign" in the perfusion phase due to the increased perfusion of spermatic cord vessels. In acute epididymitis scrotal scan showed increased activity spanning spermatic cord vessels and scrotum in the perfusion phase, and increased curvilinear activity in the tissue phase. In scrotal abscess increased perfusion from spermatic cord vessels and pudendal artery were observed in the perfusion phase. In the tissue phase increased dartos perfusion and a cold area due to the formation of abscess was observed. In varicocele, increased perfusion in the location which corresponded to the pampiniform plexus of the vein was observed in venous phase.

Topics: Adult; Epididymitis; Genital Diseases, Male; Humans; Male; Radionuclide Imaging; Scrotum; Sodium Pertechnetate Tc 99m; Spermatic Cord Torsion; Testicular Neoplasms; Testis

Seventy-five patients with suspected testicular torsion who had scintiscans and adequate clinical follow-up were analyzed retrospectively. The scintiscans diagnosed 12/13 cases of surgically proven missed torsion and 3/3 cases of surgically proven acute complete torsion. The scintiscans successfully distinguished all 35 cases of epididymo-orchitis, 14 cases of torsion of the appendix testes and 8 other miscellaneous conditions from testicular torsion. The incidence of testicular torsion in our patients undergoing scrotal scintigraphy was approximately 24%.

Topics: Adolescent; Age Factors; Child; Diagnosis, Differential; Epididymitis; Humans; Infant, Newborn; Male; Orchitis; Radionuclide Imaging; Retrospective Studies; Sodium Pertechnetate Tc 99m; Spermatic Cord Torsion; Testis

Emergency room physicians frequently are faced with the evaluation of the patient with acute testicular pain. The rapid differentiation between testicular torsion and acute epididymitis is necessary although frequently difficult due to an atypical presentation. We describe four patients with testicular pain in whom testicular scanning provided useful adjunctive information regarding diagnosis. This technique clearly differentiates acute torsion, acute epididymitis, testicular rupture, and missed torsion with abscess formation, prompting appropriate therapy in each case. Testicular scanning provides a rapid, noninvasive method to assist in the evaluation of testicular pain.

Topics: Adolescent; Adult; Diagnosis, Differential; Epididymitis; Humans; Male; Radionuclide Imaging; Rupture; Sodium Pertechnetate Tc 99m; Spermatic Cord Torsion; Testis

Topics: Adolescent; Adult; Aged; Child; Child, Preschool; Diagnosis, Differential; Epididymitis; Humans; Male; Middle Aged; Radionuclide Imaging; Sodium Pertechnetate Tc 99m; Spermatic Cord Torsion; Technetium Tc 99m Aggregated Albumin; Ultrasonography

Scrotal imaging with technetium-99m sodium pertechnetate consists of a radionuclide angiogram and static scrotal scans. Utilization of this study in patients presenting with an acute scrotum can dramatically reduce the number of surgical explorations for acute epididymitis. It can also aid in other aspects of differential diagnosis in patients presenting with either an acutely enlarged and/or painful scrotum or a scrotal mass. Ambiguities in previous descriptions of perfusion through the spermatic and extraspermatic cord vessels are described and distinguished from scrotal perfusion. The clinical and scintigraphic spectrum of testicular torsion, including spontaneous detorsion, early acute testicular torsion, midphase testicular torsion, and late phase or "missed testicular torsion," is discussed and illustrated. The variety of patterns seen in acute epididymitis, including lateral and medial epididymal location, and focal epididymitis are described, as is the appearance of hydrocele as both a primary and secondary entity. The relationship of scrotal imaging to the overall clinical presentation and evaluation of these patients is emphasized in testicular torsion, torsion of the testicular appendages, epididymitis, abscess, trauma, tumor, spermatocele, and varicocele. The techniques, clinical utility, and relationship to radionuclide imaging of Doppler ultrasound and gray scale ultrasound scanning are reviewed. Doppler ultrasound results in many false negative studies in testicular torsion. Gray scale ultrasound is useful in clarifying the nature of scrotal masses.

Topics: Abscess; Epididymitis; Humans; Male; Radionuclide Imaging; Scrotum; Sodium Pertechnetate Tc 99m; Spermatic Cord Torsion; Spermatocele; Technetium; Testicular Hydrocele; Testicular Neoplasms; Ultrasonography; Varicocele