Simone Agostini MD, Abstract Co-Author: Nothing to Disclose

Francesco Mondaini, Presenter: Nothing to Disclose

Tommaso Lombardi, Abstract Co-Author: Nothing to Disclose

Federico Lanzi, Abstract Co-Author: Nothing to Disclose

Antonella Verrioli, Abstract Co-Author: Nothing to Disclose

Ilario Menchi MD, Abstract Co-Author: Nothing to Disclose

Lorenzo Masieri, Abstract Co-Author: Nothing to Disclose

To assess the effectiveness of scrotal ultrasound (SUS) in the management of chronic scrotal pain (CSP)  

58 consecutive patients (pts) with continuous or intermittent scrotal pain for at least 3 months were prospectively evaluated. The study group was subdivided in two cohorts on the basis of the presence (Group A, 31 pts, 53%) or absence (Group B, 27 pts, 47%) of clinical findings on physical examination (PE). The ecographic study was performed with high-frequency probes (7.5-13MHz), integrated by color and power Doppler.  

In Group A, SUS confirmed and further defined the PE findings in 23/31 pts, with concordance of 74%. In Group B, SUS was negative in 11/27 pts, concordant with PE in 41% of the cases. Overall, additional pathological findings were identified in 8/31 cases in Group A and 16/27 in Group B, generally constituted by microlithiasis, small hernias, sub clinical varicoceles and chronic inflammation. SUS was found to have sensitivity of 58.9%, specificity of 57.8%. positive predictive value of 74.2% and negative predictive value of 40.7%. In Group A SUS modified the management in 2 cases. One pt had hypo-echogenic micro-nodularity progressively increasing in size on follow-up study and treated surgically with finding of hyaline fibrosis. Another pt was found to have a hyper-echogenic mass in the tail of the epididymis, confirmed by MR, stable in size at follow up, consistent with fibroma. In Group B the clinical management was modified by the SUS findings in 4 cases. Two pts had positional anomalies compatible with “bell-clapper deformity”; both pts were successfully treated surgically. In two pts a testicular mass (3 and 6mm) was identified. One pt, with evidence of increase in size of the mass at follow-up study, underwent orchiectomy with pathologic diagnosis of a seminoma. The other pt is currently on follow up with stable size of the nodule.  

SUS has not proven to be a definitive exam for the definition of the pathogenesis of CSP. However, the test is simple, non–invasive and able to better define the clinical findings in this setting. Moreover, in a subset of patients, SUS may determine critical changes in therapeutic strategy.  

Scrotal US is usually required in the assessment of patients with chronic scrotal pain. This single-center prospective study evaluates the role of ultrasound in the management of these patients.

Agostini, S, Mondaini, F, Lombardi, T, Lanzi, F, Verrioli, A, Menchi, I, Masieri, L, Value of Scrotal Ultrasound in Patients with Chronic Scrotal Pain: A Single Centre Prospective Study.  Radiological Society of North America 2010 Scientific Assembly and Annual Meeting, November 28 - December 3, 2010 ,Chicago IL. http://archive.rsna.org/2010/9015373.html