Imaging of the acute scrotum

The scrotum is a superficial structure and clinical examination is frequent ly not enough for making a specific diagnosis. In acute scrotal pain US can confirm the presumptive clinical diagnosis and provide additional relevant information. In testicular torsion, color-Doppler imaging has a central ro le since it has become possible to identify it at early stage by showing ab sence of perfusion in the affected testis before any gray-scale abnormality . Scintigraphy remains a satisfactory alternative in evaluating testicular torsion and should be used when color Doppler is inadequate, raising doubts about the suspected torsion. Diagnosis of torsion of testicular appendages is particularly difficult. Ischemic infarction shows a characteristic patt ern at gray-scale and color-Doppler imaging, whereas hemorrhagic ischemia m ay require MRI. Inflammatory diseases of the scrotum can be easily investig ated by echo color Doppler and conventional radiography, and CT can be part icularly useful in the detection of gas bubbles. In scrotal trauma, scrotal hematoma, hematocele, intratesticular hematoma, and testicular rupture can be identified using gray-scale US with very good reliability. Magnetic res onance imaging is indicated when a small tear of tunica albuginea is suspec ted but not visualized on US.