Thermal imaging in the diagnosis of acute testicular pain – results of a feasibility pilot study
DOI:
https://doi.org/10.2340/sju.v61.45714Keywords:
Testicular torsion, torsion of testicular appendix, acute testicular pain, thermal imagingAbstract
Objective: This study aimed to evaluate the feasibility of thermal imaging for the diagnosis of acute testicular pain. Pain is usually caused by infection, inflammation or torsion of the testis or testicular appendage. Diagnosis is based on examination, laboratory tests, and Doppler ultrasound (DU), which is investigator dependent and may cause delays. Thermal imaging is a fast and noninvasive method for measuring surface temperature.
Materials and methods: Our 3-month pilot study investigated the feasibility of thermal imaging for the diagnosis of acute testicular pain. Eighteen consecutive patients were examined using a thermal camera.
Results: Two patients had testicular torsion (group 1), two had torsion of the testicular appendage (group 2), four had bacterial epididymitis (group 3), and 10 had inflammatory epididymitis (group 4). The mean ± standard deviation (SD) temperature differences between symptomatic and a reference asymptomatic testicles were −0.65 ± 0.57°C (range, −1.1 to −0.2°C), −0.15 ± 0.21°C (range, −0.3 to 0.0°C), +0.65 ± 0.25°C (range, +0.4 to +1.0°C), and +0.39 ± 0.87°C (range, −1.0 to +1.8°C) in groups 1, 2, 3, and 4, respectively.
Conclusions: Thermal imaging is a feasible, noninvasive method for evaluating acute testicular pain. It may serve as a rapid diagnostic tool, but its clinical value must be confirmed in large prospective trials.
Downloads
References
Mansbach JM, Forbes P, Peters C. Testicular torsion and risk factors for orchiectomy. Arch Pediatr Adolesc Med. 2005;159:1167–1171.
https://doi.org/10.1001/archpedi.159.12.1167 DOI: https://doi.org/10.1001/archpedi.159.12.1167
Zhao LC, Lautz TB, Meeks JJ, Maizels M. Pediatric testicular torsion epidemiology using a national database: incidence, risk of orchiectomy and possible measures toward improving the quality of care. J Urol 2011;186:2009–13.
https://doi.org/10.1016/j.juro.2011.07.024 DOI: https://doi.org/10.1016/j.juro.2011.07.024
Kalfa N, Veyrac C, Lopez M, et al. Multicenter assessment of ultrasound of the spermatic cord in children with acute scrotum. J Urol. 2007;177:297–301; discussion 301.
https://doi.org/10.1016/j.juro.2006.08.128 DOI: https://doi.org/10.1016/j.juro.2006.08.128
Altinkilic B, Pilatz A, Weidner W. Detection of normal intratesticular perfusion using color coded duplex sonography obviates need for scrotal exploration in patients with suspected testicular torsion. J Urol. 2013;189:1853–1858.
https://doi.org/10.1016/j.juro.2012.11.166 DOI: https://doi.org/10.1016/j.juro.2012.11.166
Pepe P, Panella P, Pennisi M, et al. Does color Doppler sonography improve the clinical assessment of patients with acute scrotum? Eur J Radiol. 2006;60:120–124.
https://doi.org/10.1016/j.ejrad.2006.04.016 DOI: https://doi.org/10.1016/j.ejrad.2006.04.016
Nussbaum Blask AR, Bulas D, Shalaby-Rana E, et al. 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.
https://doi.org/10.1097/00006565-200204000-00001 DOI: https://doi.org/10.1097/00006565-200204000-00001
Chan EP, Wang PZT, Myslik F, et al. Identifying systems delays in assessment, diagnosis, and operative management for testicular torsion in a single-payer health-care system. J Pediatr Urol. 2019;15:251.e1–251.e7.
https://doi.org/10.1016/j.jpurol.2019.03.017 DOI: https://doi.org/10.1016/j.jpurol.2019.03.017
Romao RLP, Anderson KH, MacLellan D, et al. Point-of-care influences orchiectomy rates in pediatric patients with testicular torsion. J Pediatr Urol. 2019;15:367.e1–367.e7.
https://doi.org/10.1016/j.jpurol.2019.04.014 DOI: https://doi.org/10.1016/j.jpurol.2019.04.014
Ramachandra P, Palazzi KL, Holmes NM, et al. Factors influencing rate of testicular salvage in acute testicular torsion at a tertiary pediatric center. West J Emerg Med. 2015;16:190–194.
https://doi.org/10.5811/westjem.2014.11.22495 DOI: https://doi.org/10.5811/westjem.2014.11.22495
Even L, Abbo O, Le Mandat A, et al. [Testicular torsion in children: Factors influencing delayed treatment and orchiectomy rate]. Arch Pediatr Organe Off Soc Francaise Pediatr. 2013;20:364–368.
https://doi.org/10.1016/j.arcped.2013.01.008 DOI: https://doi.org/10.1016/j.arcped.2013.01.008
Leape LL. Torsion of the testis. Invitation to error. JAMA. 1967;200:669–672. DOI: https://doi.org/10.1001/jama.1967.03120210055008
Abbas TO, Abdelkareem M, Alhadi A, et al. Suspected testicular torsion in children: diagnostic dilemma and recommendation for a lower threshold for initiation of surgical exploration. Res Rep Urol. 2018;10:241–249.
https://doi.org/10.2147/RRU.S186112 DOI: https://doi.org/10.2147/RRU.S186112
Mellick LB, Sinex JE, Gibson RW, et al. A systematic review of testicle survival time after a torsion event. Pediatr Emerg Care. 2019;35:821–825.
https://doi.org/10.1097/PEC.0000000000001287 DOI: https://doi.org/10.1097/PEC.0000000000001287
Bandarkar AN, Blask AR. Testicular torsion with preserved flow: key sonographic features and value-added approach to diagnosis. Pediatr Radiol. 2018;48:735–744.
https://doi.org/10.1007/s00247-018-4093-0 DOI: https://doi.org/10.1007/s00247-018-4093-0
MacDonald C, Kronfli R, Carachi R, et al. A systematic review and meta-analysis revealing realistic outcomes following paediatric torsion of testes. J Pediatr Urol. 2018;14:503–509.
https://doi.org/10.1016/j.jpurol.2018.09.017 DOI: https://doi.org/10.1016/j.jpurol.2018.09.017
Wright HG, Wright HJ. Ultrasound use in suspected testicular torsion: an association with delay to theatre and increased intraoperative finding of non-viable testicle. N Z Med J. 2021;134:50–55.
Capraro GA, Coughlin BF, Mader TJ, et al. Testicular cooling associated with testicular torsion and its detection by infrared thermography: an experimental study in sheep. J Urol. 2008;180:2688–2693.
https://doi.org/10.1016/j.juro.2008.08.004 DOI: https://doi.org/10.1016/j.juro.2008.08.004
Brooks JP, Brooks JM, Seals T. Smartphone thermal imaging in the detection of testicular ischemia. Urology. 2021;157:233–238.
https://doi.org/10.1016/j.urology.2021.02.031 DOI: https://doi.org/10.1016/j.urology.2021.02.031
van Netten JJ, van Baal JG, Liu C, et al. Infrared thermal imaging for automated detection of diabetic foot complications. J Diabetes Sci Technol. 2013;7:1122–1129.
https://doi.org/10.1177/193229681300700504 DOI: https://doi.org/10.1177/193229681300700504
Kulis T, Knezevic M, Karlovic K, et al. Infrared digital thermography of scrotum in early selection of progressive varicocele. Med Hypotheses. 2013;81:544–546.
https://doi.org/10.1016/j.mehy.2013.06.028 DOI: https://doi.org/10.1016/j.mehy.2013.06.028
Published
How to Cite
Issue
Section
License
Copyright (c) 2026 Lasse Hirvonen, Konrad Sopyllo, Juhani Rantakallio, Ilkka Paaso, Mika Raitanen

This work is licensed under a Creative Commons Attribution 4.0 International License.
As from Volume 59 (2024) all published articles, unless otherwise specified, are published under CC-BY license, allowing third parties to copy and redistribute the material in any medium or format and to remix, transform, and build upon the material, with the condition of proper attribution to the original work.

