The validity of grayscale and color Doppler ultrasound in assessment of scrotal swellings: a retrospective study in a large case series.

BACKGROUND: Scrotal swellings have a non-specific clinical picture, so their clinical diagnosis is challenging. Scrotal grayscale and color Doppler ultrasound are non-invasive methods used in both adult and childhood groups and act as accurate screening and diagnostic modalities. PURPOSE: To evaluate the diagnostic validity of grayscale and color Doppler ultrasound in the assessment of scrotal swelling to reach accurate diagnosis. MATERIAL AND METHODS: A retrospective study included 181 patients (mean age = 35.5 ± 7.3, age range = 1-71 years) with scrotal swelling. Examinations were performed by an experienced radiologist using grayscale and color Doppler ultrasound. The diagnostic validity of grayscale and color Doppler ultrasound for diagnosing scrotal swelling were estimated using surgical findings, histopathological results, and imaging and clinical follow-up as reference standards. RESULTS: Overall, 202 scrotal swellings were detected. The final diagnoses were 13 (6.4%) malignant and 189 (93.6%) benign alterations. Varicocele was the most common scrotal swelling (26%), followed by hydrocele (23.8%). Matched to the reference standards, grayscale and color Doppler ultrasound represented a sensitivity of 84.6% (95% confidence interval [CI] = 54.6-98.1), a specificity of 76.2% (95% CI = 69.5-82.1), a positive predictive value of 19.6% (95% CI = 10.2-32.4), and a negative predictive value of 98.6% (95% CI = 95.1-99.8) for diagnosing scrotal tumors. CONCLUSION: Scrotal grayscale and color Doppler ultrasound provide high diagnostic validity for assessment of scrotal swellings.

VOLUMETRIC CLASSIFICATION OF INGUINOSCROTAL SWELLINGS.

Background: External hernias and scrotal swellings are diverse in presentation and are described in many subjective ways. Aim: To create an objective classification of inguinoscrotal swellings in the rural setting. Patients and methods: It was a prospective study on the measurement of inguinoscrotal swellings volume/contents in a cohort of surgical patients in a provincial general hospital in the north of Sierra Leone over a three-year period. For inguinal hernias and other scrotal swellings, the volume ranges of 0- 500ml were used in the classification; for femoral and other external hernias which generally do not reach 'huge' sizes, the volume ranges of 0-100 ml were used. Results: A total of 962 external hernias and hydroceles were classified over a 3- year period. Most, 610 (63.4%) were inguino-scrotal hernias, others were hydroceles, 303 (31.0%) and femoral hernias, 42 (4.3%). The remaining small number consisted of umbilical (4) and epigastric (3) hernias. For the common conditions of hydroceles, inguinal and femoral hernias, about 50% were 'small', more than 40% were 'large', the rest were giant. The same findings were true for epigastric and umbilical hernias. Conclusion: Using the scale that we adopted, majority of the groin hernias and hydroceles were in the small and large categories with a few giant varieties. Volumetric-based classification of hernias and hydroceles can help surgeons communicate more clearly based on standard rather than arbitrary ascription of descriptive terminologies to these very common surgical entities.

Idiopathic Scrotal Calcinosis.

Idiopathic scrotal calcinosis (ISC) is a rare benign condition which presents with multiple, asymptomatic, and painless nodules on the scrotal skin wall. The lesions have been attributed as sebaceous cysts, calcified steatocystoma, fibroma, atheroma, and xanthoma. Shapiro et al. reviewed the histologic data and found no evidence of an epithelial lining, residual cysts, and lipid or organisms, and concluded that the calcification was idiopathic introducing the term "idiopathic scrotal calcinosis." We have studied four cases of idiopathic scrotal calcinosis, one of which had scrotal calcinosis involving the whole of the scrotum. He presented with painless multiple nodules over the scrotum. He was subjected for surgery with SOS skin grafting, but as the scrotal skin is so lax, primary closure is easily possible. In all our four cases, primary closure was easily possible.

A rare case of intratesticular leiomyoma.

A 47-year-old man presented with a scrotal swelling. Ultrasonography of the testes showed that it was an extratesticular swelling. However, the swelling was intraoperatively found to be intratesticular. Histology showed an intratesticular leiomyoma, which is extremely rare.