sodium-pertechnetate-tc-99m and Spermatic-Cord-Torsion

A 24-yr-old male who experienced fleeting episodes of left scrotal pain since the age of 13 had an ultrasound that suggested testicular duplication on the side (triorchidism). Five months later he had acute left scrotal pain lasting for 12 hr. At that time routine scrotal scintigraphy revealed late torsion and an additional sitting view demonstrated triorchidism. Literature review indicates that in this rare condition there is an increased risk of torsion. In only two prior reports did an ultrasound examination suggest triorchidism preoperatively.

Topics: Adult; Humans; Male; Radionuclide Imaging; Risk Factors; Sodium Pertechnetate Tc 99m; Spermatic Cord Torsion; Testis

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

We reported a case of torsion of the undescended testis in a 9-month-old boy which was diagnosed with 99mTc testicular scin-tigraphy. The scan showed diffuse increased activity in the location of the undescended testis and no photopenic area was visible. At surgery, torsion of the undescended testis was detected and fixed.

Topics: Cryptorchidism; Humans; Infant; Male; Radionuclide Imaging; Radiopharmaceuticals; Sodium Pertechnetate Tc 99m; Spermatic Cord Torsion

Since the early 1970s testicular scintigraphy has been used to diagnose the cause of acute scrotal pain. The advent of Doppler sonography further enhances diagnosis by providing simultaneous real-time scrotal imaging with superimposed testicular blood flow information.. To assess the diagnostic value of Doppler sonography in patients with acute scrotal pain and scintigraphic findings suggestive of testicular torsion.. Seventy-five patients with acute scrotal pain underwent testicular scintigraphy and Doppler sonography. All patients who had scintigraphic findings suggestive of testicular torsion were included in the study and their files were retrospectively reviewed.. Twenty-seven patients had scintigraphic findings suggestive of testicular torsion. Radionuclide scintigraphy accurately detected all cases of testicular torsion. However, abscess, hematoma, hydrocele and other conditions simulated testicular torsion on scintigraphy, lowering the test specificity. These pathologies were clarified by Doppler sonography that was 95% specific and 86% sensitive for testicular torsion.. Doppler sonography should be used as the first-line modality in the evaluation of patients with suspected testicular torsion. Scintigraphy should be performed only in certain settings of equivocal sonographic findings to prevent false negative sonographic diagnosis.

Topics: Acute Disease; Adolescent; Adult; Artifacts; Blood Flow Velocity; Child; Child, Preschool; Diagnosis, Differential; Diagnostic Errors; Humans; Infant; Male; Mass Screening; Middle Aged; Radionuclide Imaging; Radiopharmaceuticals; Retrospective Studies; Sensitivity and Specificity; Sodium Pertechnetate Tc 99m; Spermatic Cord Torsion; Time Factors; Ultrasonography, Doppler

Topics: Child; Epididymis; Erythrocytes; Humans; Male; Radionuclide Imaging; Radiopharmaceuticals; Sodium Pertechnetate Tc 99m; Spermatic Cord Torsion

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

Topics: Humans; Male; Radionuclide Imaging; Retrospective Studies; Sensitivity and Specificity; Sodium Pertechnetate Tc 99m; Spermatic Cord Torsion

To compare the usefulness of conventional color Doppler ultrasound (US), unenhanced and contrast material-enhanced power Doppler US, and radionuclide imaging in a model of acute testicular torsion.. Twenty rabbits underwent unilateral 360 degree testis torsion and contralateral orchiopexy. Gray-scale, color Doppler, and unenhanced and contrast-enhanced power Doppler US were performed 4-6 hours later. The side of torsion was determined, and intratestis flow was graded. Within 2 hours of US, technetium-99m pertechnetate was intravenously administered, the rabbits were killed, and the testes excised for radionuclide imaging.. Intratestis perfusion was detected in 85% of torsed testes at US and radionuclide imaging. The side of torsion was correctly diagnosed in 25% of cases with radionuclide imaging and in 60% of cases with US. Power Doppler US demonstrated significantly greater intratestis flow in pexed than in torsed testes. Although the numbers of correct diagnosis with the three US modalities were similar, flow grades within torsed and normal testes were significantly different.. Perfusion to torsed and normal testes was demonstrated equally well with color Doppler US, power Doppler US, and radionuclide imaging. Doppler US better depicted differences in intratesticular flow between torsed and normal testes.

Topics: Acute Disease; Animals; Contrast Media; Male; Polysaccharides; Rabbits; Radionuclide Imaging; Regional Blood Flow; Sensitivity and Specificity; Sodium Pertechnetate Tc 99m; Spermatic Cord Torsion; Testis; Time Factors; Ultrasonography, Doppler, Color

The aim of this study was to define the radionuclide scrotal imaging (RSI) pattern in cases of torsion of testicular appendages and to correlate it with the duration of symptoms. Two hundred and seventeen patients with acute scrotal pain were evaluated prospectively during the past 13 years. Two groups of patients were defined according to the interval between the onset of symptoms and the performance of RSI: group A comprised patients in whom RSI was performed within 5 h after the onset of symptoms, while group B comprised patients in whom RSI was performed between 5 and 24 h after the onset of symptoms. An SPX-4 Elscint or an Apex 405 gamma camera with a parallel hole or converging collimator was used. Between 5 and 15 mCi of technetium-99m pertechnetate was injected as a bolus intravenously. The radionuclide angiogram consisted of six to eight consecutive 5-s frames. The scrotal static scan was obtained immediately following the radionuclide angiogram. The "hot dot" sign, which is a small spot of increased tracer perfusion and uptake on RSI, was not present during the first hours after the onset of symptoms. Therefore, RSI is inaccurate and is not indicated for the diagnosis of torsion of testicular appendages of less than 4-5 h duration. The hot dot sign was, however, demonstrated on the RSI in 45% of the patients with scrotal pain lasting between 5 and 24 h. The overall sensitivity and accuracy of RSI in diagnosing torsion of testicular appendages in this group of patients were 68% and 79%, respectively. In all the patients with a positive hot dot sign, torsion of testicular appendages was found at exploration (specificity 100%). Therefore, the hot dot sign was found to be pathognomonic of torsion of testicular appendages.

Topics: Adolescent; Adult; Case-Control Studies; Child; Child, Preschool; Humans; Male; Prospective Studies; Radionuclide Angiography; Sensitivity and Specificity; Sodium Pertechnetate Tc 99m; Spermatic Cord Torsion; Time Factors

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

12 cases of testicular torsion were stadieded. It is helpful to get diagnosis for early testicular torsion using radionuclide testicular imaging, B-ultrasound and color Doppler flow imaging. A peculiar type of testicular torsion was unilateral defect of radionuclide distribution. The causes, diagnoses and treatments of testicular torsion were discussed in detail.

Topics: Adolescent; Adult; Aged; Diagnosis, Differential; Humans; Male; Middle Aged; Orchiectomy; Radionuclide Imaging; Sodium Pertechnetate Tc 99m; Spermatic Cord Torsion; Testis; Ultrasonography, Doppler, Color

Topics: Acute Disease; Adolescent; Humans; Male; Radionuclide Imaging; Reflex; Sodium Pertechnetate Tc 99m; Spermatic Cord Torsion; Thigh

Topics: Adult; Diagnosis, Differential; Hernia, Inguinal; Humans; Male; Radionuclide Imaging; Sodium Pertechnetate Tc 99m; Spermatic Cord Torsion

Topics: Acute Disease; Adult; Diagnosis, Differential; Hernia, Inguinal; Humans; Male; Radionuclide Imaging; Scrotum; Sodium Pertechnetate Tc 99m; Spermatic Cord Torsion

Topics: Cryptorchidism; Humans; Infant; 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

Tc-99m pertechnetate radionuclide scrotal scanning was performed on nine hospitalized boys with anaphylactoid purpura and acute scrotal tenderness. Scrotal involvement in anaphylactoid purpura is generally a part of the basic pathological process (i.e., vasculitis). Sometimes testicular torsion could not be excluded by physical examination. Tc-99m radionuclide scan was proven to be a useful tool, enabling distinction between the two processes. In all the patients the scan showed increased flow to the scrotum, compatible with inflammation of the scrotal wall and normal testicular perfusion, ruling out testicular torsion. All the boys were treated conservatively, with rapid resolution of the scrotal symptoms.

Topics: Child; Child, Preschool; Diagnosis, Differential; Humans; IgA Vasculitis; Male; Radionuclide Angiography; Scrotum; Sodium Pertechnetate Tc 99m; Spermatic Cord Torsion; Testicular Diseases

RP-30A is a radioactive tracer being evaluated for the detection of regional myocardial blood flow. This study compares RP-30A to technetium 99m pertechnetate as radioactive tracers for the detection of testicular blood flow changes in early testicular torsion. The left testis of adult male Sprague-Dawley rats was subjected to either thirty or sixty minutes of 720 degrees torsion. Injections of RP-30A or 99mTc-pertechnetate followed by sacrifice and scintillation counting of the testes was performed. No significant difference was detected between the torted testes and the right control testes in both groups receiving 99mTc-pertechnetate and the thirty-minute group receiving RP-30A. The torted testes of the sixty-minute group receiving RP-30A revealed a significant difference (decrease) in uptake indicating that RP-30A may be a more sensitive tracer in detecting testicular blood flow changes in early testicular torsion.

Topics: Animals; Humans; Male; Nitriles; Organotechnetium Compounds; Radionuclide Imaging; Rats; Rats, Inbred Strains; Regional Blood Flow; Sodium Pertechnetate Tc 99m; Spermatic Cord Torsion; Technetium Tc 99m Sestamibi; Testis

Testicular blood flows during unilateral testicular torsion were measured by Xenon-133 clearance technique. Xenon-133 was injected via the left carotid artery into the heart. Measurements were performed in control and left-sided testicular torsion groups, each consisting of ten rats. Left and right testicular blood flows, which were 29.157 +/- 2.272 ml/100 g/min and 29.773 +/- 2.934 ml/100 g/min in the controls, were 11.983 +/- 3.655 ml/100 g/min and 16.098 +/- 3.757 ml/100 g/min in the experimental group and differed significantly. The decrease in contralateral testicular blood flow may play an important role in the contralateral testicular damage encountered following unilateral testicular torsion.

Topics: Animals; Male; Radionuclide Imaging; Rats; Regional Blood Flow; Sodium Pertechnetate Tc 99m; Spermatic Cord Torsion; Testis; Xenon Radioisotopes

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

High resolution color doppler ultrasound can simultaneously display blood flow superimposed on detailed gray scale anatomic images. Using a single-blind study design, nine adult male dogs underwent intravaginal spermatic cord torsion and subsequent evaluation with technetium 99M-pertechnetate radionuclide, and color doppler ultrasound imaging techniques. Torsions of 90 to 720 degrees were created surgically, followed by examination with each modality at one hour (four animals), and four hours (five animals) following the procedure. Testicular torsion was diagnosed if perfusion was absent or markedly diminished on color doppler imaging or radionuclide scan. In all cases of 360 degrees or greater, torsion was diagnosed by either modality at both one and four hour time delays. If observers did not diagnose torsion, they were asked to assess the relative testicular perfusion. Color doppler ultrasound and radionuclide scanning were without error in correctly detecting a relative decrease in perfusion in each of these instances. Furthermore, color doppler imaging with spectral analysis was able to detect an enhancement of the diastolic component of the arterial signal at 180 degrees of torsion. This spectral pattern coupled with a relative decrease in blood flow allowed presumptive diagnosis at one hour of partial torsion that was subsequently apparent as absent perfusion only after 4 hours on radionuclide and repeat color doppler ultrasound. Color doppler ultrasound proved to be superior to radionuclide scanning in detecting diminished perfusion in this experiment. The detailed information provided by spectral and anatomic display with color doppler ultrasound recommends it for the evaluation of acute scrotal pathology of uncertain etiology.

Topics: Animals; Male; Radionuclide Imaging; Regional Blood Flow; Sodium Pertechnetate Tc 99m; Spermatic Cord Torsion; Testis; Ultrasonics; Ultrasonography

A patient with a nontender testicular mass had sonographic abnormalities compatible with but not entirely typical of a chronic torsion. His scintigraphic studies, done on the same day as ultrasonography and 1 month later, revealed only findings consistent with a very mild subsiding scrotal inflammatory process. On surgical exploration and pathologic examination, it was found that he had an organizing infarct of the testicle secondary to torsion. The clinical history, diagnostic studies, and microscopic slides of the surgical specimen were reviewed. It appeared that tissue granulation and lipogranulomatous changes in the epididymis, known histologic sequelae to the unusually prolonged testicular torsion of 2-3 months, produced scintigraphic findings different from those which have been described for a late or an atrophic torsion.

Topics: Adolescent; Humans; Male; Radionuclide Imaging; Sodium Pertechnetate Tc 99m; Spermatic Cord Torsion; Testis; Time Factors; Ultrasonography

The role of technetium-99m pertechnetate imaging in acute testicular torsion is well appreciated. Manual testicular detorsion under local anesthesia may be performed in the nuclear medicine clinic by the urology service immediately following initial diagnostic scintigraphy. Following manual testicular detorsion, continued images of the testes are obtained up to 30 minutes without having to reinject the patient with technetium-99m pertechnetate. Reperfusion of the affected testicle will be dramatically noted if the manual detorsion is successful. Four cases are presented to illustrate this.

Topics: Acute Disease; Adolescent; Adult; Humans; Male; Radionuclide Imaging; Regional Blood Flow; Sodium Pertechnetate Tc 99m; Spermatic Cord Torsion; Testis

Sodium pertechnetate Tc99m scintigraphy is a valuable technique for the evaluation of acute testicular torsion in postpubescent males. However, in neonates and children with small testicles, the method is less reliable. Since the testicles of adult rats and young children are of similar size, the reliability of testicular imaging for detecting torsion was evaluated in this species. The utility of the radionuclide angiogram (RA) and static images were determined in 17 anesthetized animals before, 2 h after and 20 h after ligation of the left spermatic cord. The preligation RA was asymmetric in 27% of animals, while the static images were abnormal in 18%. Postligation flow and static images were abnormal in 57% and 82% of the animals (localized to the correct side, 38% and 36%), respectively. The animals with vascular occlusion failed to show any statistically significant greater incidence of decreased radionuclide accumulation on the ligated side. To determine the influence of relative perfusion and extracellular fluid space of the scrotum and testicles on the images, additional studies were performed with 201Tl (representing perfusion) and 99mTcO4- (representing ECF space). Perfusion was approximately equal in the testis and epididymis but significantly higher in the scrotum. These results suggest that scrotal scintigraphy is unreliable for detecting acute torsion of small testicles.

Topics: Animals; Male; Radionuclide Angiography; Rats; Rats, Inbred Strains; Sodium Pertechnetate Tc 99m; Spermatic Cord Torsion; Thallium Radioisotopes; Tissue Distribution

Twenty-five patients suffering from acute painful testicular processes were subjected to scintigraphy. Testicular torsion in the early and delayed phases were diagnosed with 100% accuracy, but one out of 7 cases of epididymitis was wrongly recognized as negative. Interoperative diagnosis in two cases of hydatid torsion proved the foregoing scintigraphic finding to have been wrong. Nevertheless, scintigraphy was found to be reliable in testicular torsion diagnosis.

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

Topics: Adolescent; Humans; Male; Radionuclide Imaging; Scrotum; Sodium Pertechnetate Tc 99m; 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

Topics: Cryptorchidism; Humans; Infant; Male; Radionuclide Imaging; Sodium Pertechnetate Tc 99m; Spermatic Cord Torsion

Radionuclide imaging is the diagnostic procedure of choice for evaluation of acute disorders of the scrotum, permitting rapid differentiation of torsion of the spermatic cord from inflammatory processes. The method is less successful in diagnosing torsion of the testicular appendages. In the majority of reported cases of torsion of the appendix testis the scan appears normal. In a very limited number of cases increased perfusion to the affected side has been noted. We report a case of metachronous torsion of both the appendices testis. In each instance, there was decreased tracer uptake on the affected side, suggestive of early torsion of the testicle. The sequential involvement of each testis with a nine month interval between respective torsions provides a unique example where each testis serves, sequentially, as a normal control for the torsed contralateral appendage.

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

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

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

To distinguish spermatic cord torsion from other intrascrotal pathology, scrotal ultrasound and radionuclide scanning have been highly recommended on the basis of both clinical and experimental studies. We review the data from six patients in whom ultrasound or nuclear medicine examination was misleading. We emphasize that history, physical examination, and urinalysis remain the cornerstones of the diagnosis of spermatic cord torsion. Scrotal ultrasound and nuclear medicine scans are useful adjuncts and are reassuring when in agreement with the clinical picture. However, they are not 100% sensitive or specific, and a negative study should not prevent emergency operative exploration of a clinically suspicious lesion.

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

A rare case of epidermoid cyst of the testis, represented scintigraphically by an area of avascularity in the affected testicle, is described. The differential diagnosis from epididymitis and torsion of testis, and the diagnostic value fo the scintigraphic method to rule out malignant (vascular) testicular tumors, is emphasized.

Topics: Adult; Diagnosis, Differential; Epidermal Cyst; Humans; Male; Radionuclide Imaging; Sodium Pertechnetate Tc 99m; Spermatic Cord Torsion; Testicular Diseases

Topics: Acute Disease; Adolescent; Adult; Child; Child, Preschool; Humans; Infant; Male; Radionuclide Imaging; Scrotum; Sodium Pertechnetate Tc 99m; Spermatic Cord Torsion

Technetium-99m sodium pertechnetate scintigraphy is an established method for evaluating organ perfusion and can be applied to the investigation of suspected testicular ischaemia due to acute torsion. One hundred and six consecutive scrotal investigations have been analysed qualitatively and quantitatively using a computer-based comparison of the perfusion slopes over each testis. Decreased vascularity on the symptomatic side only occurs in torsion and quantitative analysis is needed to detect it reliably. Increased vascularity on the symptomatic side can usually be detected qualitatively and occurs in orchitis, tumours, trauma and resolved torsion. Distinction between the causes of increased vascularity is aided by the clinical data. A halo of increased activity surrounding a relatively cold centre was seen in chronic torsion, some tumours and hydrocoeles. The test is both sensitive and specific for acute torsion but its usefulness is limited if it is not available at all hours. The test is useful, also, in confirming a diagnosis that does not require emergency operation and in identifying chronic torsion which is an indication for contralateral orchidopexy.

Topics: Acute Disease; Adolescent; Adult; Aged; Child; Child, Preschool; Diagnosis, Differential; Humans; Male; Middle Aged; Perfusion; Radionuclide Imaging; Scrotum; Sodium Pertechnetate Tc 99m; Spermatic Cord Torsion; Technetium; Testicular Diseases

Causes of a hyperemic peritesticular rim on dynamic and static scintigrams are reviewed. Of 6 patients exhibiting such a pattern, 3 had missed testicular torsion; the other 3 had tumor, trauma, or inflammation. The authors conclude that a hyperemic peritesticular rim is a nonspecific finding reflecting underlying pathophysiological changes and is not pathognomonic of missed torsion.

Topics: Adolescent; Adult; Humans; Male; Middle Aged; Radionuclide Imaging; Scrotum; Sodium Pertechnetate Tc 99m; Spermatic Cord Torsion; Technetium; Time Factors

An additional sign of testicular torsion on radionuclide scanning is a retracted, slightly "hot" testis.

Topics: Adolescent; Humans; Male; Radionuclide Imaging; Sodium Pertechnetate Tc 99m; Spermatic Cord Torsion; Technetium; Testis

The testicular scintigraphic findings of nine patients with surgically and pathologically proved torsion of the testis of over 24 hours duration are reviewed. In the delayed blood-pool images each showed the classical avascular twisted testicle with a variable peripheral rim of hyperemia. In the dynamic blood-flow phase, eight revealed a perceptible increase of vascular perfusion in the scrotal region on the affected side, in addition to the testicular radionuclide angiogram peculiarities previously described for missed testicular torsion. This pattern of perfusion was seen only in torsion of over one day duration. A low salvage probability is expected in these cases.

Topics: Adolescent; Adult; Blood Flow Velocity; Humans; Male; Radionuclide Imaging; Scrotum; Sodium Pertechnetate Tc 99m; Spermatic Cord Torsion; Technetium

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

Pinhole imaging of the testis was done in ten boys with suspected testicular torsion. In three of the ten cases, pinhold images were easier to interpret than images obtained with a converging collimator. In six of the ten cases, pinhold images were required for interpretation of the study, because converging images could not be interpreted.

Topics: Adolescent; Age Factors; Child; Child, Preschool; Humans; Image Enhancement; Male; Pentetic Acid; Radionuclide Imaging; Sodium Pertechnetate Tc 99m; Spermatic Cord Torsion; Technetium; Technetium Tc 99m Pentetate; Testis