Multicenter assessment of ultrasound of the spermatic cord in children with acute scrotum.
OBJECTIVE
Intravaginal or extravaginal spermatic cord torsion is a diagnostic challenge for the surgeon and radiologist. Color Doppler sonography can be inaccurate, leading to dangerous false-negative results. To date, no single reliable test has been able to provide 100% diagnostic accuracy. The direct visualization of the twisted cord during emergency high resolution ultrasonography has been proposed to avoid systematic and abusive surgical exploration. The aim of this multicenter study was to assess the validity and reproducibility of high resolution ultrasonography based management of acute scrotum in children.


METHODS
A total of 919 patients from 11 European university hospitals underwent color Doppler sonography and high resolution ultrasonography for acute scrotum between 1992 and 2005. The spermatic cord was studied along its complete length to detect a spiral twist. The surgical findings were correlated with the preoperative results.


RESULTS
A total of 208 patients had spermatic cord torsion proved at surgery. Intratesticular vascularization was absent in the affected testis in only 158 cases (76%). In contrast, high resolution ultrasonography detected the twist as a snail shell-shaped mass, measuring 7 to 33 mm, in 199 patients (96%). High resolution ultrasonography revealed a linear cord for all other causes of acute scrotum (711 patients) with a specificity of 99%. The radiologist training level was the best predictive factor of high resolution ultrasonography reliability (p <0.05).


CONCLUSIONS
High resolution ultrasonography based management of acute scrotum is reliable and reproducible. Thanks to its high sensitivity and specificity for the diagnosis of spermatic cord torsion, high resolution ultrasonography can significantly improve the management of acute scrotum in children.
Kalfa
Nicolas
N
Department of Visceral Pediatric Surgery and Pediatric Urology, Lapeyronie Hospital, CHU Montpellier, France. nicolaskal@aol.com
Veyrac
Corinne
C
Lopez
Manuel
M
Lopez
Christophe
C
Maurel
Aude
A
Kaselas
Christos
C
Sibai
Samir
S
Arena
Francesco
F
Vaos
George
G
Bréaud
Jean
J
Merrot
Thierry
T
Kalfa
David
D
Khochman
Issam
I
Mironescu
Aurel
A
Minaev
Sergey
S
Avérous
Michel
M
Galifer
René-Benoit
RB
D000208:Acute Disease; D002648:Child; D006801:Humans; D008297:Male; D015203:Reproducibility of Results; D013086:Spermatic Cord Torsion / Q000000981:diagnostic imaging*; D014463:Ultrasonography