Differentiating acute epididymitis from testicular torsion using scrotal scintigraphy

Abstract

Introduction: In patients with acute scrotal pain, differentiating acute epididymitis from testicular torsion should be made promptly and accurately, to treat the underlying cause correctly. Acute epididymitis is treated with a simple course of antibiotics while testicular torsion requires emergency surgical exploration to salvage the testis. The assessment of patients with acute scrotal pain is done mainly using color Doppler ultrasonography, which, however, requires skills and has limitations of being highly operator-dependent and uncomfortable to patients with scrotal pains because it may take too long to perform and often involves probe compression. Scrotal scintigraphy using 99m Tc-pertechnetate may provide an alternative reproducible, quick noninvasive and reliable nuclear medicine functional imaging technique that could be used in the evaluation of patients with acute scrotal pain. The aim of this study is to document our clinical experiences with the use of scrotal scintigraphy in differentiating acute epididymitis from testicular torsion in patients with acute scrotal pain. Material and Method: All scrotal scintigraphy performed in our institution between 2007 and 2015 were included in this study. Scrotal scintigraphy was performed after intravenous administration of 99m Tc-pertechnetate radiotracer and images were acquired using MEDISO dual-headed gamma camera. Acute epididymitis is diagnosed when there is increased blood flow on dynamic images and increased uptake around the region of the epididymis, while testicular torsion as decreased blood flow and photopenic area in the testis on dynamic and static images, respectively. The final diagnosis was documented based on relief of symptoms after a course of antibiotics or surgical exploration. Results: All patients were examined by urologist and only patients in whom the differentiation between acute epididymitis and torsion could not be made clinically were include in this study. A total of 21 patients were studied. There were 16 patients diagnosed with acute epididymitis and five patients with testicular torsion. Conclusion: Our study demonstrates that scrotal scintigraphy is a simple, accurate, and effective functional imaging technique that can differentiate acute epididymitis from testicular torsion in selected patients presenting with acute scrotal pain.

Keywords

• Acute epididymitis
• scrotal scintigraphy
• testicular torsion