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Congress: ECR25
Poster Number: C-12903
Type: Poster: EPOS Radiologist (educational)
Authorblock: F. Jabbar, D. Huang, G. T. Yusuf, M. Sellars, P. S. Sidhu; London/UK
Disclosures:
Faiz Jabbar: Nothing to disclose
Dean Huang: Nothing to disclose
Gibran Timothy Yusuf: Nothing to disclose
Maria Sellars: Nothing to disclose
Paul S. Sidhu: Nothing to disclose
Keywords: Genital / Reproductive system male, Ultrasound, Contrast agent-intravenous, Cysts, Ischaemia / Infarction
Learning objectives This exhibit illustrates the role of contrast enhanced ultrasound (CEUS) in scrotal imaging, highlighting its value in definitively identifying the absence of vascularity. By providing this critical information, CEUS aids clinical decision-making across various scrotal pathologies and informs management and follow-up. Specific examples include cases of ischaemia, infarction, trauma, and sepsis.
Read more Background Assessing tissue vascularisation is fundamental in characterising scrotal abnormalities. Colour Doppler ultrasound (CDUS) is commonly used to evaluate focal lesions [1-4]; However, its limitations—such as insufficient sensitivity in low-flow states—can lead to diagnostic challenges and potential misdiagnoses [5]. The first systematic study of contrast enhanced ultrasound for scrotal evaluation was reported in 2009 [6]. A key strength of CEUS lies in its ability to conclusively differentiate vascularised from non-vascularised components of scrotal contents. The technique’s capability to depict vascularity at...
Read more Findings and procedure details Contrast Enhanced Ultrasound of the Scrotum: TechniquesA scrotal CEUS examination is performed with the patient in the supine position, the penis lifted onto the abdomen and covered for privacy. After identifying a scrotal abnormality using initial greyscale ultrasound and CDUS, CEUS is employed. The procedure involves a bolus injection of an ultrasound contrast agent (UCA), administered via a 22-gauge cannula inserted into the antecubital vein.  The most widely used microbubble UCA for the assessment of scrotal disease is Lumason™/SonoVue™ (Bracco...
Read more Conclusion The incorporation of contrast enhanced ultrasound adds a critical dimension to the evaluation of scrotal diseases. Its unique ability to conclusively demonstrate the absence of vascularity is essential for diagnosing global or segmental infarctions and identifying haematomas or abscesses, allowing more informed clinical decision-making and improving both diagnosis and management outcomes.
Read more References   Horstman, W.G.; Middleton, W.D.; Melson, G.L.; Siegel, B.A. Color Doppler US of the scrotum. Radiographics : a review publication of the Radiological Society of North America, Inc 1991, 6, 941-957. Dieckmann, K.P.; Frey, U.; Lock, G. Contemporary diagnostic work-up of testicular germ cell tumours. Nature reviews. Urology 2013, 10, 703-712, doi:10.1038/nrurol.2013.254. Huang, D.Y.; Sidhu, P.S. Focal testicular lesions: colour Doppler ultrasound, contrast-enhanced ultrasound and tissue elastography as adjuvants to the diagnosis. The British journal of radiology 2012, 85 Spec No 1, S41-53,...
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