Emergency ultrasound of acute scrotal pain

Patients presenting with acute scrotal pain to the emergency department require a timely diagnosis. Although the differential diagnosis can be extensive and varies with age, there are a few conditions that are considered true surgical emergencies. These include torsion of the spermatic cord, incarcerated hernia with strangulation, testicular trauma leading to rupture or organ-threatening hematomas, and Fournier's gangrene. These are conditions that need to be kept in mind by the physician when approaching such patients. Other causes such as epididymitis or orchitis need to be distinguished, and although not requiring emergency surgery, still require urgent diagnosis and treatment. Diagnostic ultrasound can accurately diagnose many acute conditions of the scrotum, and emergency physicians have come to utilize it to advance their diagnostic acumen. This educational review article discusses the current literature and the use of emergency ultrasound in patients presenting with scrotal pain as well as scanning approaches and common sonographic findings.