The Impact of the Sonographic Findings Within the Epididymis on the Differential Diagnosis of Acute Scrotum

Objective: The aim of this study was to assess the sonographic changes within the testis, epididymis, and the corresponding appendages, in contributing to the pediatric differential diagnosis, of an acute scrotum. Materials and Methods: A retrospective extraction of pediatric patients’ (age <13 years) data was completed for those initially seen with an acute scrotum. The data procured from the medical records included demographic characteristics, clinical and sonographic findings, and the final diagnosis. Results: The final diagnoses among a cohort of 86 pediatric males (average age 6 ± 3.9 years) with acute scrotum were as follows: epididymal and testicular appendix torsion (44.7% and 17.6%, respectively), testicular torsion (15.3%), trauma and hematoma (5.9%), incarcerated hernia (4.7%), idiopathic scrotal edema (4.7%), epididymitis (4.7%), and Henoch-Schonlein purpura (3.5%). The heterogeneous testicular appearance in patients with testicular torsion was significantly compared with the appendix torsion. The increased testicle size noted on the sonogram favored the diagnosis of testicular torsion. In cases of testicular torsion, the vascular flow was reduced or absent, although it was normal or increased in appendix torsion. Increased epididymal vascular flow was more common in cases of appendix torsion. Conclusion: Based on the diagnostic findings in this cohort, the following were the most common and accurate sonographic findings in distinguishing the causes of a pediatric acute scrotum: an epididymis enlargement coexisting with a small adjacent avascular mass, due to the torsion of intra-scrotal appendages and a mass shape of the epididymis.