Sonographic findings in patients presenting with Scrotal pain referred for ultrasound at Moi Teaching and referral hospital - Eldoret, Kenya

Abstract

Background: The most common causes of scrotal pain include torsion, epididymitis, trauma and testicular cancer. These entities may be clinically indistinguishable because characteristic symptoms and signs for each overlap. High frequency ultrasonography with Colour Doppler has become the imaging modality used to supplement the physical examination of the scrotum and is an accurate, reliable, safe and relatively inexpensive means of evaluating scrotal pain. Objective: To determine the pattern of sonographic findings in patients presenting with scrotal pain and referred for sonography at Moi Teaching and Referral Hospital, Eldoret. Methods: This is cross sectional descriptive study done in the Department of Radiology and Imaging, Moi Teaching and Referral Hospital between July 2014 and July 2015. A total of 57 consecutively sampled patients aged 2 to 80yrs with scrotal pain underwent scrotal ultrasonography. A high-frequency (7-12 MHz) linear array transducer of either a Philips HD11 XE machine model 2006 or Aloka Prosound Alpha 7 machine was used. All the images were reviewed by two consultant radiologists. Descriptive statistics were summarized for patient socio-demographics. Frequency tables were generated for categorical variables. Results were presented using tables and charts. Results: The patients ranged in age from 2 to 80 years (mean 30.96 years). Majority of the patients were in 21-30 years age group comprising 45.6% followed by 31- 40 years comprising 17.5%. Pain with swelling was found to be the most common presenting complaint.Of the 57 patients with scrotal pain 14 had epididymitis, 13 had epididymo orchitis, 5 had torsion, 4 had hydrocele, 4 had varicocele, 3 had epididymal cyst, 2 had trauma, 2 had hernia, 2 had scrotal mass, 1 had scrotal abscess and 1 had scrotal edema. No abnormality was seen on ultrasound in 5 patients. Epididymitis was the most common cause of scrotal pain in adults while torsion was more common in the younger age group. Epididymal lesions were seen in 52.6% of the patients. Epididymal enlargement was seen in 86% of the cases of acute epididymitis. The majority of the lesions observed were either hypoechoic or heterogenous in echotexture. Hydrocele was present in most cases of epididymitis (64.3%), epididymo-orchitis (53.8%) and in some cases of testicular torsion (20%). Conclusion: Epididymitis is the most common cause of scrotal pain. Ultrasound provides optimal anatomic detail and when color Doppler imaging is added, testicular perfusion can be assessed. Torsion of the testis remains the most urgent and important entity dependent on ultrasonography for diagnosis. Recommendation: Scrotal ultrasound evaluation is recommended in all patients presenting with scrotal pain