Torsion of the Testicular Appendices and Epididymis Guidelines

Updated: Feb 02, 2022
  • Author: Jason S Chang, MD; Chief Editor: Erik D Schraga, MD  more...
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Guidelines Summary

The American College of Radiology has published the following guidelines for treating patients with acute scrotum [22] :

  • When the clinician has a strong clinical suspicion of testicular torsion, the patient may be referred promptly for scrotal exploration.

  • Color Doppler ultrasonography (CDU) with grayscale imaging and special attention to the spermatic cord is the study of choice for evaluating patients with acute scrotal pain because of its widespread availability and its ability to diagnose testicular torsion with a high degree of sensitivity and specificity and to distinguish other causes of scrotal pain and swelling.

  • Radionuclide scrotal imaging (RNSI) is used infrequently because of longer examination times, less availability, use of radiation, and diminished diagnostic capability in young boys.

  • If CDU is performed and results are equivocal for testicular torsion, scrotal exploration may be undertaken.

  • Studies are needed to explore the role of MRI in patients who have acute scrotal pain but equivocal CDU findings.