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Ultrasound in the diagnosis of testicular torsion
  1. Zain Kapasi, Senior House Officer in Emergency Medicine,
  2. Steve Halliday, Senior House Officer in Emergency Medicine
  1. Department of Emergency Medicine, Manchester Royal Infirmary, Oxford Road, Manchester M13 9WL, UK; kevin mackway-jonesman.ac.uk

    Abstract

    A short cut review was carried out to establish whether colour Doppler ultrasound is more sensitive than clinical examination in ruling out testicular torsion. A total of 284 papers were found using the reported search, of which seven presented the best evidence to answer the clinical question. The author, date and country of publication, patient group studied, study type, relevant outcomes, results, and study weaknesses of these best papers are tabulated. A clinical bottom line is stated.

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    Report by Zain Kapasi, Senior House Officer in Emergency MedicineChecked by Steve Halliday, Senior House Officer in Emergency Medicine

    Clinical scenario

    A 15 year old boy presents to the emergency department with gradual onset testicular pain which has been present for the last six hours. On examination he has marked tenderness on the left side with normally placed testicles. There is a moderate left sided swelling and mild erythema, and he describes some recent dysuria. You wonder if colour Doppler ultrasound can help you to accurately rule out torsion and thus prevent this boy going for surgery unnecessarily?

    Three part question

    [In patients with testicular pain] is [ultrasound better than clinical examination] at [ruling out testicular torsion]?

    Search strategy

    Medline 1966–March week 4 2005, Embase 1980–week 13 2005, and Cochrane Library Issue 1 2005. Medline: (exp spermatic cord torsion/OR testi$ adj torsion.mp) OR (exp testis/AND torsion.mp). AND (exp ultrasonography/OR ultraso$.mp.). Limit to Human and English Language. A total of 223 articles found. Embase: [(exp testis torsion/OR testi$ adj torsion.mp.).)] AND [(exp echography/OR exp Doppler Flowmetry/or exp Doppler Echography/or exp Color Ultrasound Flowmetry/OR ultraso$.mp.)] Limit to Human and English Language. A total of 284 papers found. Cochrane Library: [torsion (mesh this term only) AND testis (mesh explode) OR spermatic cord torsion (mesh explode)] AND (ultrasonograpy (mesh explode)). Four articles found.

    Search outcome

    Overall 284 papers were found, of which seven were relevant and of sufficient quality for inclusion (see table 2).

    Table 2

    Comment(s)

    Some of the studies that were found are over 10 years old and the technology available for ultrasound has changed considerably since that time. New ultrasound techniques that attempt to identify a twisted cord as opposed to blood flow to the testicle appear promising. The results presented do not suggest that ultrasonography alone can rule out testicular torsion. It may be that it can perform this function in cases with low or even moderate clinical suspiscion—but this question has not been addressed.

    CLINICAL BOTTOM LINE

    Ultrasound examination is a useful addition to clinical examination and experience but should not overrule clinical suspicion.

    Report by Zain Kapasi, Senior House Officer in Emergency MedicineChecked by Steve Halliday, Senior House Officer in Emergency Medicine

    References

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