The work of Bird et al1 was available to us only in abstract form before our article was published, but after reviewing the complete report, we still believe that the role of B-scan ultrasonography in the evaluation of the acute scrotum is unclear.Any imaging technique used to evaluate acute scrotal swelling must allow diagnosis within the first few hours after the onset of symptoms and should accurately differentiate torsion from epididymitis involving the testicle (epididymo-orchitis). Bird et al made no attempt to separate acute torsion from epididymo-orchitis and other nonsurgical lesions. Since ten of the 12 testes they evaluated were necrotic, they also failed to demonstrate that they could diagnose torsion early and, as Dr Wosick noted, recommended Doppler studies or radionuclide scanning for early diagnosis. Other investigators have found it impossible to separate torsion from epididymo-orchitis using B-scan ultrasound.2,3Does this mean that B-scan
Haynes BE, Bessen HA, Haynes VE. Scrotal Imaging Techniques-Reply. JAMA. 1984;251(4):469–470. doi:10.1001/jama.1984.03340280025016
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