title: ACR Appropriateness Criteria ® acute onset of scrotal pain--without trauma, without antecedent mass.
abstract: Men or boys, who present with acute scrotal pain without prior trauma or a known mass, most commonly suffer from torsion of the spermatic cord; epididymitis or epididymoorchitis; or torsion of the testicular appendages. Less common causes of pain include a strangulated hernia, segmental testicular infarction, or a previously undiagnosed testicular tumor. Ultrasound is the study of choice to distinguish these disorders; it has supplanted Tc-99 m scrotal scintigraphy for the diagnosis of spermatic cord torsion. MRI should be used in a problem solving role if the ultrasound examination is inconclusive. The ACR Appropriateness Criteria ® are evidence-based guidelines for specific clinical conditions that are reviewed every two years by a multidisciplinary expert panel. The guideline development and review include an extensive analysis of current medical literature from peer reviewed journals and the application of a well-established consensus methodology (modified Delphi) to rate the appropriateness of imaging and treatment procedures by the panel. In those instances where evidence is lacking or not definitive, expert opinion may be used to recommend imaging or treatment.
authors.affiliation: Department of Radiology, Cleveland Clinic, Cleveland, Ohio 44195-0001, USA. remere1@ccf.org
authors.forename: Erick M
authors.initials: EM
authors.lastname: Remer
authors.forename: David D
authors.initials: DD
authors.lastname: Casalino
authors.forename: Ronald S
authors.initials: RS
authors.lastname: Arellano
authors.forename: Jay T
authors.initials: JT
authors.lastname: Bishoff
authors.forename: Courtney A
authors.initials: CA
authors.lastname: Coursey
authors.forename: Manjiri
authors.initials: M
authors.lastname: Dighe
authors.forename: Pat
authors.initials: P
authors.lastname: Fulgham
authors.forename: Gary M
authors.initials: GM
authors.lastname: Israel
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Lazarus
authors.forename: John R
authors.initials: JR
authors.lastname: Leyendecker
authors.forename: Massoud
authors.initials: M
authors.lastname: Majd
authors.forename: Paul
authors.initials: P
authors.lastname: Nikolaidis
authors.forename: Nicholas
authors.initials: N
authors.lastname: Papanicolaou
authors.forename: Srinivasa
authors.initials: S
authors.lastname: Prasad
authors.forename: Parvati
authors.initials: P
authors.lastname: Ramchandani
authors.forename: Sheila
authors.initials: S
authors.lastname: Sheth
authors.forename: Raghunandan
authors.initials: R
authors.lastname: Vikram
authors.forename: Boaz
authors.initials: B
authors.lastname: Karmazyn
mesh_terms: D059787:Acute Pain / Q000175:diagnosis* / Q000209:etiology; D003937:Diagnosis, Differential; D003952:Diagnostic Imaging / Q000379:methods* / Q000592:standards; D006801:Humans; D008297:Male; D017699:Pelvic Pain / Q000175:diagnosis* / Q000209:etiology; D017410:Practice Guidelines as Topic; D015203:Reproducibility of Results; D012611:Scrotum; D013733:Testicular Diseases / Q000150:complications* / Q000175:diagnosis