Peds-Genitourinary

16 yo male who presents with left testicular pain. Exam with horizontal left testicle. POCUS shows blood flow to both testicles, however left distal spermatic cord demonstrates whirlpool sign, consistent with intermittent/partial torsion.

Dr. Paul Khalil and Dr. Joshua Kim - University of Louisville

@kjosh317

Normal testicle buddy view with color. The buddy view is the best place to start when doing as testicular ultrasound to compare the echogenicity, size, blood flow and position of the testicles.

Contributor: Paul Khalil, MD Nicklaus Children's Hospital @khalil3paul

Normal spermatic cord. Flow should be linear as apposed to the "corkscrew" sign in torsion.

Contributor: Paul Khalil, MD Nicklaus Children's Hospital @khalil3paul

2 yo male present with testicle pain and swelling. POCUS shows torsion of the appendix of the testicle. Please note hyperechoic appendage of testicle.

Contributor: Paul Khalil, MD, Nicklaus Children's Hospital, @khalil3paul

13 yo male presents with intermittent testicular pain. There was some flow to testicle, but when examining spermatic cord flow was twisted (corkscrew sign) indicating partial torsion.

Contributor: Paul Khalil, MD and Joshua Kim, DO

2 yo male with testicular torsion presenting at 48 hrs. Note the twisted spermatic cord, change of echogenicity of testicle and reactive hydrocele.

Contributor: Paul Khalil, MD Nicklaus Children's Hospital @khalil3paul

Normal adolescent uterus.

Contributor: Paul Khalil, MD Nicklaus Children's Hospital @khalil3paul

Normal Adolescent Ovary (transabdominal).

Contributor: Paul Khalil, MD Nicklaus Children's Hospital @khalil3paul

14 yo male presents with right testicular pain. POCUS shows high riding testicle with absent flow in buddy view as well as isolated view. Image one is the isolated view. Image 2 depicts buddy view. Case Series 1 of 2

14 yo male presents with right testicular pain. POCUS shows high riding testicle with absent flow in buddy view as well as isolated view. Image one is the isolated view. Image 2 depicts buddy view. Case Series 2 of 2

15 yo M with sudden onset testicular pain (left) and vomiting. POCUS shows decreased flow to the left testicle consistent with torsion. he was taken immediately to the OR.

Contributor: Kathryn Pade, MD, Rady Children's Hospital San Diego

Incidental finding of a Wilm's tumor in 3 yo female presenting to the PED with fever and lower abdominal pain. Educational scan that turned out to significantly alter management. Pt had right nephrectomy of localized tumor. Case Series 2 of 2

Contributor: Melinda Tonelli MD, University of Rochester, Rochester NY

Incidental finding of a Wilm's tumor in 3 yo female presenting to the PED with fever and lower abdominal pain. Educational scan that turned out to significantly alter management. Pt had right nephrectomy of localized tumor. Case Series 1 of 2

Contributor: Melinda Tonelli MD, University of Rochester, Rochester NY

16 year old male with right testicular pain and swelling presented to the emergency department, a POCUS was done showing increased flow in the left testicle along with surrounding edema.

This ultrasound clip demonstrates the enlarged testicle with surrounding edema.

Diagnosis of orchitis was made and confirmed with radiology performed ultrasound.

Contributor: Zach Boivin, MD, @ZachBoivinMD

14 year old male presented with scrotal swelling, POCUS identified a hernia into the scrotum. This clip shows normal testicles along with bowel in the scrotum.

Contributor: Zach Boivin, MD, @ZachBoivinMD

16 year old female with abdominal/pelvic pain. POCUS demonstrated bilateral ovarian teratomas. Shown here is a transverse pelvic view at the level of the uterine fundus focused in the L adnexa. A large complex mass with mixed hypoechoic and hyperechoic content is seen in the L adnexa, and a second similar-appearing mass can be partially seen in the R adnexa.

Contributor: Matthew Moake, MD PhD

16 year old male with right testicular pain and swelling presented to the emergency department, a POCUS was done showing increased flow in the left testicle along with surrounding edema.

This ultrasound clip demonstrates increased flow to the left testicle. This can be better appreciated when compared in a side by side view to the normal testicle.

Diagnosis of orchitis was made and confirmed with radiology performed ultrasound.

Contributor: Zach Boivin, MD, @ZachBoivinMD

11 year old male presenting for left flank pain and headache. POCUS with severe left sided hydronephrosis without stone.

Contributor: Matthew Moake, MD PhD

16 year old with right sided flank pain. Patient found to have severe hydronephrosis.

Contributor: Kathryn Pade, MD

Healthy 7 year old male modeling for educational US scanning. Found to have large simple large renal cyst.

Contributor: Matthew Moake, MD PhD

2 week old with scrotal swelling found to have indirect inguinal hernia. Bowel contents can be seen present in this clip in the scrotum with some surrounding fluid.

Contributor: Kathryn Pade, MD

Normal testicular ultrasound in 8 year old with testicular pain.

Contributor: Zach Boivin, MD, @ZachBoivinMD

2 year female with history of febrile UTI. Normal right kidney. Note the hypoechoic renal pyramids, which can be misinterpreted as being hydronephrosis.

Contributor: Matthew Moake, MD PhD

14 year old female presenting with acute on chronic abdominal pain. Physical exam revealed gross abdominal distension in the pelvic region. She denied hematuria, dysuria, or sensation of incomplete voiding. No menarche reported.

In this clip, the patient's bladder is difficult to visualize due to the mass effect of the enlarged, blood-filled vagina. The uterus contains blood as well, but to a much lesser degree than the vagina.

Contributor: Jaron Smith, MD Phoenix Children's Hospital