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Introduction ⬇

A testicular scan is performed on an emergency basis to evaluate acute, painful testicular swelling. It also is used in the differential diagnosis of torsion or acute epididymitis and in evaluation of injury, trauma, tumors, and masses. The scan is obtained after radiopharmaceutical 99mTc pertechnetate is injected intravenously. The images obtained differentiate lesions associated with increased perfusion from those that are primarily ischemic. For pediatric patients, the test is done to diagnose acute or latent testicular torsion, epididymitis, or testicular hydrocele and for evaluation of testicular masses such as abscesses and tumors. Presently, however, a testicular ultrasound has replaced the testicular scan for identifying testicular torsion and tumors.

Procedure ⬆ ⬇

  1. Have the patient lie supine under the gamma camera. Tape the penis gently to the lower abdominal wall. For proper positioning, use towels to support the scrotum. Place lead shielding in the perineal area to reduce any background activity.

  2. Inject the radionuclide intravenously. For pediatric patients, do not inject the radiopharmaceutical through veins in the legs because this interferes with the study.

  3. Perform imaging in two phases (15 minutes apart): first as a dynamic blood flow study of the scrotum and second as an assessment of distribution of the radiopharmaceutical in the scrotum.

  4. Advise the patient that total examining time is 30–45 minutes.

  5. See Chapter 1 guidelines for safe, effective, informed intratest care.

Clinical Implications ⬆ ⬇

  1. Abnormal concentrations reveal:

    1. Tumors

    2. Hematomas

    3. Infection

    4. Torsion (with reduced blood flow): In the neonatal patient, torsion is caused primarily by developmental anomalies

    5. Acute epididymitis

  2. The NMI is most specific soon after the onset of pain.

Interventions ⬆ ⬇

Pretest Patient Care

  1. Explain the purpose, procedure, benefits, and risks of the test. Tell the patient that there is no discomfort involved in testing.

  2. If the patient is a child, have a parent or caregiver accompany the child to the department, if possible.

  3. Tape the penis to the lower abdominal wall.

  4. Refer to standard NMI pretest precautions.

  5. Follow guidelines in Chapter 1 for safe, effective, informed pretest care.

Posttest Patient Care

  1. Refer to standard nuclear imaging posttest precautions.

  2. Review test results; report and record findings with the patient, parents, or caregiver, as indicated. Modify the nursing care plan as needed.

  3. Follow guidelines in Chapter 1 for safe, effective, informed posttest care.

Reference Values ⬆

Normal

Normal blood flow to scrotal structures, with even distribution and concentration of the radiopharmaceutical