Nuclear scanning with Tech 99m pertechnitate has evolved as a major diagnostic tool for evaluating the paediatric patients with acute scrotum. It is simple, quick and accurate for differentiating the patients with testicular torsion from other causes of acute scrotum.Between march 2001 and march 2007,we prospectively studied 148 patients with acute scrotum;out of whom 91 patients were subjected to nuclear scanning.10 patients(9.9%)were diagnosed as having testicular torsion which was confirmed on surgical exploration(accuracy 100%).one patient had epididymo orchitis and one patient had missed torsion..79 patients had normal scan;All the patients with normal scan were managed conservatively with no adverse sequelae on follow up. Introduction The acute scrotum occurs with 1/20th the frequency of acute abdominal pain and consequently a few clinicians can boast of a large personal experience in dealing with acute scrotum [1]. Torsion of testis or spermatic cord is undoubtedly the most serious of the conditions affecting the scrotum[2]. The principal challenge to the clinician is the prompt and accurate diagnosis. Despite sophisticated diagnostic techniques distinguishing testicular torsion from other causes of acute scrotum, it still remains a clinical challenge.Nuclear scanning of the testes has become the investigation of choice for acute scrotal swellings.[2,3,5]. Rapid sequential imaging with technetium 99m pertechintate along with additional views employing a pinhole collimator provide the optimal results. In testicular torsion scintigraphic images show decreased flow-early phase (6 hrs); halo of mildly increased activity surrounding a cold centre - mid phase (18 hr) and a strongly emitting halo around a cold centre-late phase (missed torsion)[2,3]. Epididymitis is manifested by a markedly increased blood flow to affected side with no cold area of under perfusion. A similar pattern can be found with torsion of appendicular structures[2]. Careful application of this technique leads to high rates of accuracy in distinguishing testicular torsion from appendicular torsion and epididymoorchitis. Material And Methods This study was conducted over a period of 6 years from March 2001 to march 2007. The patients in the age group of 0-13 years, who presented with acute scrotal were included in the study. After detailed history and physical examination, routine examinations like hemogram, serum chemistry, urine examination were obtained in all patients. The patients presenting with unequivocal clinical picture of the torsion of testis were subjected to scrotal exploration without delay. All other patients with equivocal clinical presentation were subjected to radioisotope testicular scan.D oppler ultrasonography was performed whenever necessary.TechniqueAll the patients undergoing Tc99m scintigraphy were given potassium pertechnitate 0.1 mg/kg body weight orally two hours before the procedure to block thyroid uptake. After two hours the patients were positioned supine, with the scrotum elevated on tape sling and a towel between the legs. The penis is retracted cephalic with adhesive tape to avoid superimposition of its vascularity over the scrotal images. If marked asymmetry of scrotal halves was found due to unilateral enlargement of the scrotum, realignment of the median raphe of the scrotum was achieved by applying mild traction to the enlarged side using a paper adhesive and tucking it to ipsilateral thigh. Lead sheet was placed beneath scrotum to block underlying thigh activity. The gamma camera with a converging hole collimator was positioned over the scrotum. After checking the position of the gamma camera, with the help of syringe loaded with technetium, five Mcu of 99m tech pertechnitate was injected intravenously. Sequential 5 sec flow images were obtained for the first 60 sec; followed by static images. All results were reviewed by experienced nuclear physicists. A typical study completed in 20 minutes. The character of scint
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