Jay et al,
One of my suspicions is that it relates to how ultrasound is practiced in
North America vs. the rest of the world. In Canada and the USA, an
ultrasound tech usually performs the ultrasound. In many other places
around the world, I believe it is more common for the imaging specialist to
perform the scan themselves. So, there's more exploration of innovative
ways of doing the scan and getting to the diagnosis. In this case, looking
at the actual structure that is twisted (the spermatic cord) in addition to
the structure that is affected by the twist (flow in the testicle).
From: JaPe [mailto:[log in to unmask]]
Sent: Tuesday, August 18, 2009 5:37 PM
To: Steve Socransky; [log in to unmask]
Subject: Re: manual detorsion?
Steve & All,
There is similar data in the pediatric radiology literature that quotes
higher sensitivity with US assessment of the spermatic cord vs. a limited
testicular US. I wonder why this is not uniformally practiced? Our
sonologists tell me that the newer US machines are much better at detecting
subtle changes in blood flow or is it a training issue? At the end of the
day, if clinical suspicion is high, exploration is still the best strategy!
Le Bonheur ED
From: Steve Socransky <[log in to unmask]>
Here's one of the more recent and better articles on the topic:
Kalfa et al. Multicenter Assessment of Ultrasound of the Spermatic Cord in
Children With Acute Scrotum. J Urol. 2007; 177:297-301.
Point taken! Similar to your hospital, reviewing the spermatic cord for a
"twist" is not part of the protocol for our our US techs and radiologists.
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