Value and limits of testicular scintigraphy in paediatric acute scrotum

Abrupt onset of scrotal symptoms is a not uncommon condition, particularly in the paediatric age, which raises the problem of a rapid decision concerning proper therapeutic management (i.e. surgery or pharmacotherapy); the testicular radionuclide scan is generally considered to be helpful in making this choice, as it is theoretically able to distinguish between hypervascular (inflammation) and hypovascular conditions (testicular torsion). We report our experience in paediatric patients presenting acute scrotum. Thirty consecutive cases were examined, but three were discarded because of their non-routine features. Our records show that torsion of the appendix testis is far from uncommon (6 cases out of 27); however, the scintigraphic pattern of this pathological condition, which usually does not require urgent surgical treatment, does not seem to differ greatly from that of scrotal inflammation. Of the remaining 21 cases, 15 were correctly diagnosed, while 4 were to be considered non-diagnostic because of the presence of hypovascular scrotal conditions other than testicular torsion. We conclude that, while not always a very precise tool for the diagnosis of acute scrotum, nevertheless testicular scan results may be considered a useful parameter in choosing the proper type of treatment.