B‐mode and colour‐flow duplex ultrasonography: a useful adjunct in diagnosing scrotal diseases?

Objective To determine the value of ultrasonography (US) and colour‐flow duplex ultrasonography (CFD) as routine investigations in the diagnosis of scrotal pathologies. Patients and methods The imaging techniques were applied to 215 consecutive patients with scrotal complaints. The diagnosis of a urologist (D1, made from the patient's history, physical examination and laboratory results) and that of the radiologist (D2, using US and CFD) were compared with the ‘gold standard’ (D3, the operative findings and course of the disease). The sensitivity and specificity of the diagnostic pathways (D1, D2) were determined statistically and compared with D3. Results The final diagnoses (D3) were testicular torsion (13 patients), torsion of the appendix testis (5), epididymitis (42), inguinal hernia (7), tumour (11), trauma (9), hydrocele (46), epididymal cyst (37), orchitis (10), varicocele (46) and other diagnoses (8). Using D1, the urologist missed seven diagnoses, of which one was a patient with a testicular torsion combined with an inguinal hernia, and one a patient with a tumour. Using US and CFD (D2), the radiologist missed five diagnoses, including one patient with combined testicular torsion and inguinal hernia. Conclusion For the diagnosis of scrotal disorders, the basic clinical evaluation usually provides the correct diagnosis. However, US and CFD are useful adjuncts which cause a minimal burden to the patient and that in most cases will lead to the correct diagnosis, especially with important diagnoses like testicular torsion, when US and CFD should be performed immediately. If this does not provide a clear diagnosis, the patient should be explored surgically.