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 Table of Contents     
CASE REPORT
Year : 2011  |  Volume : 26  |  Issue : 3  |  Page : 159-160  

False-positive "halo" sign on testicular scintigraphy in a 5-year-old boy with epididymitis and hydrocele


1 Department of Nuclear Medicine, Postgraduate Institute of Medical Education and Research, Chandigarh, India
2 Department of Pediatric Surgery, Postgraduate Institute of Medical Education and Research, Chandigarh, India

Date of Web Publication28-Nov-2012

Correspondence Address:
Anish Bhattacharya
Department of Nuclear Medicine, PGIMER, Chandigarh - 160012
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0972-3919.104002

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   Abstract 

Scintigraphic differentiation between acute torsion, hydrocele and testicular or scrotal abscess can be difficult. Doppler sonography may provide useful complimentary information toward diagnosis. The authors describe a 5-year-old child where epididymitis with hydrocele was misdiagnosed as testicular torsion on scrotal scintigraphy.

Keywords: Epididymitis, halo sign, hydrocele, testicular scan, torsion


How to cite this article:
Santhosh S, Guha P, Bhattacharya A, Bawa M, Mittal BR. False-positive "halo" sign on testicular scintigraphy in a 5-year-old boy with epididymitis and hydrocele. Indian J Nucl Med 2011;26:159-60

How to cite this URL:
Santhosh S, Guha P, Bhattacharya A, Bawa M, Mittal BR. False-positive "halo" sign on testicular scintigraphy in a 5-year-old boy with epididymitis and hydrocele. Indian J Nucl Med [serial online] 2011 [cited 2019 Dec 16];26:159-60. Available from: http://www.ijnm.in/text.asp?2011/26/3/159/104002


   Introduction Top


99mTc pertechnetate scintigraphy is routinely used to detect testicular torsion and differentiate this condition from acute epididymo-orchitis. However, differentiation of torsion from hydrocele and testicular or scrotal abscess may be difficult. In this report, we present a 5-year old child in whom epididymitis with hydrocele was misdiagnosed as testicular torsion on scrotal scintigraphy.


   Case Report Top


A 5-year-old boy presented to the pediatric emergency department with a complaint of left scrotal swelling and local tenderness for 7 h. Doppler ultrasound (US) imaging showed mild hydrocele of the left scrotum with no e/o torsion of the left testis. Scrotal scintigraphy was then performed after intravenous injection of 10 mCi of 99mTc pertechnetate. Static images at 5 and 10 min showed a halo-like pooling of tracer in the periphery of the left hemi-scrotum with a photopenic center and normal tracer uptake in the right hemi-scrotum [Figure 1]. A scintigraphic diagnosis of mid-phase testicular torsion of the left testis was made and the patient was immediately operated. However, it was discovered intraoperatively that the patient had epididymitis with a hydrocele and not torsion of the left testis.
Figure 1: Scrotal scintigraphy following intravenous injection of 10 mCi of 99mTc pertechnetate. Static images at 5 and 10 min show a halo-like pooling of tracer in the periphery of the left hemi-scrotum (arrow) with a photopenic centre. Normal tracer uptake is seen in the right hemi-scrotum

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Differentiation by scintigraphy between acute torsion, hydrocele, testicular or scrotal abscess, or even inguinal hernia can be difficult, and images must be interpreted in conjunction with clinical findings from scrotal transillumination. In this situation, sonography can provide useful complementary information. [1],[2],[3],[4] In a previous study comparing scintigraphy and US in children with scrotal pain, Doppler US was able to provide the diagnosis of epididymo-orchitis in cases of false-positive scintigraphy. [1] A peri-testicular hyperemic rim on radionuclide scrotal scintigraphy is not pathognomonic of missed testicular torsion. [5] Epididymitis and hydrocele have also been reported to mimic testicular torsion on scintigraphy in adults. [6],[7],[ 8] The present study describes a halo-like appearance on scrotal scintigraphy caused by epididymitis with co-existing hydrocele in a clinical setting, suggestive of testicular torsion in a child.

 
   References Top

1.Nussbaum Blask AR, Bulas D, Shalaby-Rana E, Rushton G, Shao C, Majd M. Color Doppler sonography and scintigraphy of the testis: a prospective, comparative analysis in children with acute scrotal pain. Pediatr Emerg Care 2002;18:67-71.  Back to cited text no. 1
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2.Karadeniz T, Topsakal M, Ariman A, Eksioglu A, Erton H, Ozpacaci T, et al. Prospective comparison of colour Doppler ultrasonography and testicular scintigraphy in acute scrotum. Int Urol Nephrol 1996;28:543-8.  Back to cited text no. 2
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3.Yuan Z, Luo Q, Chen L, Zhu J, Zhu R. Clinical study of scrotum scintigraphy in 49 patients with acute scrotal pain: a comparison with ultrasonography. Ann Nucl Med 2001;15:225-9.  Back to cited text no. 3
    
4.Paltiel HJ, Connolly LP, Atala A, Paltiel AD, Zurakowski D, Treves ST. Acute scrotal symptoms in boys with an indeterminate clinical presentation: comparison of color Doppler sonography and scintigraphy. Radiology 1998;207:223-31.  Back to cited text no. 4
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5.Vieras F. Kuhn CR. Nonspecificity of the "rim sign" in the scintigraphic diagnosis of missed testicular torsion. Radiology 1983;146:519-22.  Back to cited text no. 5
    
6.Palestro CJ, Finn C. Hydrocele and epididymitis mimicking testicular torsion on scrotal scintigraphy. Clin Nucl Med 1993;18:910-1.  Back to cited text no. 6
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7.Rosenson AS, Ali A, Fordham EW, Chaviano A. A false-positive scan for testicular torsion and false-negative scan for epididymitis. Clin Nucl Med 1990;15:863-4.   Back to cited text no. 7
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8.Erbay N, Brown SL, Spencer RP. Hydrocele mimicking testicular torsion on radionuclide and ultrasound studies. Clin Nucl Med 1997;22:570-1.  Back to cited text no. 8
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