Epididymal or Testicular Ultrasonic Findings: Which One is More Reliable for Differentiation of Testicular Torsion from Epididymitis?

Ultrasound is the primary modality for the evaluation of patients with acute scrotum. Accurate exclusion of testicular torsion is prevented from unnecessary surgical exploration.
We assessed scrotal changes in pediatric testicular torsion in comparison epidydimits, with purpose to determine more specific points for differentiation testicular torsion from epididymitis.
During 2011 - 2017 a descriptive case control study was performed in Dr. Sheikh and Akbar Children hospital, Mashhad medical university of science. The 41 pediatric patients with acute scrotum (21 cases with testicular torsion and 20 cases with epididymitis) were examined. Eventually, the sonographic findings were analyzed to compare the results.
Testicular and epididymal enlargement, hydrocele, the hyperemia of surrounding tissues and the scrotal skin thickening are observed in both epididymitis and torsion without any significant difference (P ≥ 0.05). Some other findings where observed in both groups with a significant difference (P ≤ 0.05) such as changes in echogenicity of testis and epididymis, abnormal testicular axis and spermatic cord changes are observed in both epididymitis and torsion; but they had low sensitivity. The most specific signs of testicular torsion were testicular parenchymal heterogenicity (94%), testicular flow pattern (94%), increased echogenicity of epididymis (73%), heterogenicity of epididymis (84%), abnormal epididymis location (100%), mass-like configuration of epididymis (100%) and epididymis flow pattern (100%). The most epididymal findings are more specific and sensitive than testicular findings.
Avascularity, heterogenicity, displacement and mass-like configuration of epididymis are reliable sonographic findings for differentiation testicular torsion from epididymitis. They have high diagnostic value with sensitivity of 75% - 100% and specificity of 84 - 100%. So, making proper use of them can minimize diagnostic pitfalls.