Role of Doppler ultrasonography in the triage of acute scrotum in the emergency department.
OBJECTIVE
The purpose of this study was to examine the triage role of scrotal Doppler ultrasonography (DUS) as the primary preoperative diagnostic tool in patients presenting to the emergency department (ED) with acute scrotum.


METHODS
Patients who presented to the ED with acute scrotum and underwent scrotal DUS in the ultrasound unit over a 3-year period (2004-2007) were included in the study. Patient characteristics, DUS findings, and clinical management were retrospectively collected and reviewed. Doppler ultrasonographic diagnoses were compared with histopathologic findings for patients who underwent exploration and with final diagnoses at the time of discharge for patients undergoing medical treatment.


RESULTS
A total of 620 consecutive patients with 669 DUS examinations were included. The most common scrotal DUS diagnoses were epididymitis, hydrocele, varicocele, and orchitis. Scrotal trauma was present in 77 cases. Hospitalization followed the initial ED evaluation for 155 patients; 68 underwent surgery. Testicular torsion was ultrasonographically suspected in 20 patients and confirmed in 18. Scrotal malignancy was incidentally diagnosed in 13 patients and testicular hematoma in 8. Doppler ultrasonography for the diagnosis of testicular torsion had 94% sensitivity, 96% specificity, 95.5% accuracy, an 89.4% positive predictive value (PPV), and a 98% negative predictive value (NPV). Doppler ultrasonography for the diagnosis of testicular malignancy had 92% sensitivity, 95% specificity, 94% accuracy, a 78.5% PPV, and a 98% NPV.


CONCLUSIONS
Scrotal DUS is a highly sensitive preoperative diagnostic tool, thereby validating its routine use in the initial triage of patients with acute scrotum presenting to the ED.
Yagil
Yael
Y
Department of Medical Imaging, Rambam Health Care Campus, PO Box 9602, Ha'Aliya St 8, 31096 Haifa, Israel.
Naroditsky
Inna
I
Milhem
Jumana
J
Leiba
Ronit
R
Leiderman
Maxim
M
Badaan
Shadie
S
Gaitini
Diana
D
D000208:Acute Disease; D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002648:Child; D002675:Child, Preschool; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data*; D006801:Humans; D007223:Infant; D007557:Israel / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D015995:Prevalence; D015203:Reproducibility of Results; D018570:Risk Assessment / Q000379:methods; D012307:Risk Factors; D012611:Scrotum / Q000000981:diagnostic imaging* / Q000293:injuries*; D012680:Sensitivity and Specificity; D013733:Testicular Diseases / Q000000981:diagnostic imaging* / Q000453:epidemiology*; D014218:Triage / Q000706:statistics & numerical data*; D018608:Ultrasonography, Doppler / Q000706:statistics & numerical data*; D055815:Young Adult