This sign may help clinically differentiate between epididymitis and torsion of the spermatic cord, in which scrotal pain is not lessened with this maneuver [14]. Testicular torsion is defined as twisting of the spermatic cord, compromising blood flow to and from the testes [2]. It is a surgical emergency with a bimodal distribution presenting more frequently in neonates and postpubertal boys than in adults, although it can occur at any age [19]. It has an estimated reported yearly incidence ranging from 2.9 to 3.8 in 100,000 boys <18 years of age [20,21]. Prompt recognition and surgical exploration within 6 to 8 hours after symptom onset is essential to prevent testicular loss [22]. A validated [23-26], clinical risk scoring system, Testicular Workup for Ischemia and Suspected Torsion Score, has shown high positive predictive value; however, it has not been widely adopted [20]. Special Imaging Considerations Contrast-enhanced ultrasound (US) has expanded considerably in the last few decades and has proved to be a useful tool in determining the presence or absence of organ perfusion by improving the signal-to-noise ratio of tissue Reprint requests to: publications@acr.org Acute Onset of Scrotal Pain Microvascular imaging US is a new Doppler module that better differentiates slow flow via mathematical algorithms based on signal amplitude width [33], by separating low frequency of static tissue artifacts from low frequencies of very weak flow. Microvascular imaging obtains a higher resolution by separating the Doppler components of the 2 different sources [34]. Shear wave elastography (SWE) is a recently developed technique capable of quantitatively evaluating soft tissue stiffness [35,36]. This serves as a surrogate marker for tissue composition.
Acute Onset of Scrotal Pain Without Trauma Without Antecedent Mass. This sign may help clinically differentiate between epididymitis and torsion of the spermatic cord, in which scrotal pain is not lessened with this maneuver [14]. Testicular torsion is defined as twisting of the spermatic cord, compromising blood flow to and from the testes [2]. It is a surgical emergency with a bimodal distribution presenting more frequently in neonates and postpubertal boys than in adults, although it can occur at any age [19]. It has an estimated reported yearly incidence ranging from 2.9 to 3.8 in 100,000 boys <18 years of age [20,21]. Prompt recognition and surgical exploration within 6 to 8 hours after symptom onset is essential to prevent testicular loss [22]. A validated [23-26], clinical risk scoring system, Testicular Workup for Ischemia and Suspected Torsion Score, has shown high positive predictive value; however, it has not been widely adopted [20]. Special Imaging Considerations Contrast-enhanced ultrasound (US) has expanded considerably in the last few decades and has proved to be a useful tool in determining the presence or absence of organ perfusion by improving the signal-to-noise ratio of tissue Reprint requests to: publications@acr.org Acute Onset of Scrotal Pain Microvascular imaging US is a new Doppler module that better differentiates slow flow via mathematical algorithms based on signal amplitude width [33], by separating low frequency of static tissue artifacts from low frequencies of very weak flow. Microvascular imaging obtains a higher resolution by separating the Doppler components of the 2 different sources [34]. Shear wave elastography (SWE) is a recently developed technique capable of quantitatively evaluating soft tissue stiffness [35,36]. This serves as a surrogate marker for tissue composition.