İletişim Bilgileri: Yasemin Şanlı e-mail: yaseminsanli75@yahoo.com İstanbul Tıp Fakültesi, Nükleer Tıp AD, Çapa, İstanbul Marmara Medical Journal 2006;19(3);132-134 CASE REPORT RADIONUCLIDE IMAGING IN DIFFERENTIAL DIAGNOSIS OF TORSION AND INFECTIONS OF TESTIS AND EPIDIDYMIS REVISITED Yasemin Şanlı 1 , Işık Adalet 1 , Handan Tokmak 1 , Öner Şanlı 2 , Orhan Ziylan 2 , Sema Cantez 1 1 Departments of Nuclear Medicine Medical Faculty of Istanbul, University of Istanbul 2 Departments of Urology, Medical Faculty of Istanbul, University of Istanbul ABSTRACT Differential diagnosis of acute scrotum especially with acute epididymis and testicular torsion should be made promptly, as testicular torsion is a true surgical emergency of the highest order. In this manuscript, two demonstrative cases introducing with acute scrotum and diagnosed with scintigraphy and color Doppler ultrasonography were presented to recall the knowledge. Keywords: Testicular torsion, radionuclide imaging, color Doppler ultrasonography RADYONUKLİD GÖRÜNTÜLEME METODU İLE TESTİS TORSİYONU TEŞHİSİ VE TESTİS VE EPİDİDİMİS ENFEKSİYONLARI ÖZET Akut skrotumun ayırıcı tanısı özellikle akut epididimit ve testis torsiyonu için hızla yapılmalıdır. Çünkü testiküler torsiyon gerçek bir cerrahi acildir. Bu makalede akut skrotal ağrısı olan ve tanısında testis sintigrafisi ve Doppler Ultrasonografisi kullanılan iki vakayı sunmayı ve bu konudaki bilgileri gözden geçirmeyi amaçladık. Anahtar Kelimeler: Testis torsiyonu, radynüklid görüntüleme, renkli Doppler Ultrasonografi INTRODUCTION Scrotal pain is an urgent condition that Urologists, Pediatricians and Pediatric surgeons frequently encounter and may have various etiologies. However, the most common two causes of this acute symptom are torsion of testicles and acute epididymitis. Differentiation of torsion from infections of testis and epididymis has a great importance because of the major differences in treatment modalities 1 Mostly, physical examination combined with color Doppler ultrasonography or testicular scintigraphy is used in differential diagnosis 2,3 . In this manuscript, we aimed to recall the utility of testicular scintigraphy in these two acute conditions using two cases. CASE REPORT Case 1 Twenty two years old white male presenting with right scrotal pain extending to the right inguinal region for 36 hours administered to our outpatient Urology clinic. Physical examination revealed right testicular tenderness and hyperemia in scrotal skin. Assessment with color Doppler ultrasonography (CDU) demonstrated an heterogenious right testis with hypoechoic paranchyma. And vascularity was diminised in the body of testis but increased in the peritesticular area. Left testis was completely normal in physical examination and CDU. An immediate testicular scintigraphy was performed due to the insignificant evidence of the testicular torsion on CDU. While patient was in the supine position in the gamma camera, 10 mCi Tc-99 m O4 was injected intravenously and 60 frames for 2 seconds were taken as a dynamic study. After that, statical images were recorded for 10 minutes. Testicular scintigraphy demonstrated an increased activity (perfusion) in the dynamical phase and a hypoactive center with a hyperactive hologram in the late static phase (Figure 1). Prompt scrotal exploration revealed the torsion of right testis with 540º, both testis and epididiymis were purple (necrotic) in color and showed no bleeding or significant change in the color after detorsion. Cord was clamped and orchiectomy was performed (Figure 2). 132