Multiparametric ultrasound in acute scrotum: a comprehensive review with special emphasis on contrast-enhanced ultrasound

Acute scrotum poses diagnostic challenges due to its diverse etiology and potential severity. Multiparametric ultrasound has proven to be a fundamental and valuable imaging modality in this context, improving early-phase sensitivity through various techniques, including B-Mode, color Doppler, power Doppler, pulsed Doppler, microflow studies, and elastography. In this context, Contrast-Enhanced Ultrasound (CEUS) emerges as a rapid, safe, and valuable tool in enhancing diagnostic accuracy and therapeutic decisions for acute scrotal conditions. This study involves a detailed analysis of various ultrasound imaging techniques and investigates the optimal circumstances and methods for employing CEUS in emergency situations to improve diagnostic accuracy and therapeutic decisions. Multiparametric ultrasound plays a crucial role in diagnosing various pathologies, including testicular torsion, appendage torsion, inflammation, ischemia/infarction, and trauma. CEUS provides real-time assessment of vascular perfusion, aiding in early diagnosis and accurate characterization of scrotal pathologies and significantly reducing the need for unnecessary surgical interventions, especially in trauma cases. Its role in differentiating between various pathologies and guiding therapeutic decisions underscores its importance in clinical practice, contributing significantly to improve patient outcomes.