彩色多普勒超声在附睾结核治疗中的应用价值

目的探讨附睾结核的彩色多普勒超声分型及其在治疗中的价值。方法对33例附睾结核患者的彩色多普勒超声表现及手术所见进行对比分析。结果对33例附睾结核患者超声正确诊断29例，诊断符合率为87．9％。3例附睾呈弥漫性病变，血供丰富；13例附睾内见结节病灶，其中3例结节内有液性无回声区，3例内有点状高回声区，7例呈低回声；17例阴囊内多发病灶，其中11例附睾表现为弥漫肿大、回声不均、血供增多。附睾结核依发生部位可将超声表现分为弥漫型、结节型、复杂型，其中结节型依回声及病理表现又分为脓性结节、钙化结节和干酪结节。结论弥漫型附睾结核容易累及睾丸，应早期手术；脓性结节以手术治疗为主；钙化结节无需手术；干酪结节先药物治疗，如效果不佳应手术治疗；复杂型必须手术治疗。超声首诊怀疑附睾结核时，系统扫查泌尿系有助于发现无症状的泌尿系结核。     

睾丸结核的临床与超声影像学特征分析

目的探讨睾丸结核的临床及超声影像学特征。 方法回顾性分析2013年1月至2020年10月西藏自治区人民医院37例临床诊断为睾丸结核的患者的临床及超声影像学资料,总结其特征。 结果37例患者中单侧睾丸结核26例,双侧睾丸结核11例。临床症状以阴囊肿大、慢性肿胀疼痛为主。超声检查表现多样,以片状低回声及混合回声（17/37,45.9%）、粟粒样结节（18/37,48.6%）、结节或肿块（6/37,16.2%）、窦道形成（8/37,21.62%）为主要超声表现,部分患者可多种征象并存。32例患者同时伴发附睾结核声像图改变,表现为附睾弥漫性增大、结节或脓肿。 结论睾丸结核的临床表现及超声声像图表现多样。详细了解相关病史,熟练掌握其超声声像图特征及鉴别诊断要点,有助于做出正确诊断。     

睾丸附件扭转的彩色多普勒超声诊断价值

目的：探讨彩色多普勒超声对睾丸附件扭转的诊断价值。方法对58例急性阴囊肿瘤的患儿进行灰阶及彩色多普勒超声检查，诊断睾丸附件扭转48例（49侧）；并对手术和保守治疗证实的48例患者的声像图进行回顾分析。结果：49例睾丸附件扭转中，超声显示睾丸附睾头间，睾丸上极和附睾头旁结节（扭转的睾丸附件）45例，结节多呈不均质高回声；42例结节内未显示血流信号，睾丸，附睾肿大及其血流信号增多41例；阴囊壁增厚39例，睾丸鞘膜积液31例，48例中，超声诊断正确45例，误诊3例，诊断符合为93．5％，结论：睾丸附睾头间及睾丸附睾旁高回声结节是睾丸附件扭转的特征性声像表现，彩色多普勒超声对本病诊断准确性高，可作为诊断睾丸附件扭转的最佳检查方法。     

超声在结核性附睾炎诊断中的价值

目的 探讨结核性附睾炎的声像图特征.方法 回顾性分析经手术证实为结核性附睾炎37例患者的声像图表现.结果 32例附睾弥漫性增大,其中6例为均匀低回声,26例回声不均;5例附睾呈结节状,其中1例为结核性脓肿.结论 结核性附睾炎具有较特异的声像图特征.     

高频超声、彩色血流图及能量图在阴囊急症诊断中的临床价值

目的 探讨应用高频超声、彩色血流图及能量图在阴囊急症诊断中的临床价值。方法 选择连续观察、追踪随访临床确诊的阴囊急症87例。其中阴囊外伤13例，急性睾丸扭转12例，急性附睾炎32例，急性睾丸炎7例，急性睾丸一附睾炎15例，急性睾丸附件扭转8例。用高频二维超声观察左、右睾丸、附睾的形态大小及内部回声等；用彩色血流图及能量图观察血供信息。结果 以睾丸一附睾内无血供诊断睾丸扭转，敏感性、特异性和准确性均为100％。以睾丸或／和附睾肿大及高血供诊断急性睾丸或／和附睾炎，敏感性94．4％、特异性97％和准确性95．4％。结论 高频超声、彩色血流图及能量图在阴囊急症诊断中有重要的临床价值，尤其是在鉴别急性睾丸扭转、急性睾丸附件扭转和急性睾丸或／和附睾炎方面有快速、准确的意义。     

小儿阴囊急症的临床特征和高频超声表现

目的 探讨小儿阴囊急症的临床特征和高频超声表现.方法 分析112例小儿阴囊急症的超声和临床表现,并与最终诊断及治疗方案对照.结果 急性附件扭转65例,超声表现为睾丸上极或附睾头旁回声不均结节,伴或不伴继发反应性炎症.睾丸完全扭转21例,超声示患侧精索螺旋状扭曲成团,睾丸内无明显血流信号;不全扭转4例,患侧精索走行纡曲,睾丸内均可测及少量低阻血流信号.急性睾丸、附睾炎22例,除1例化脓性睾丸炎外,其余病例受累结构血供增多;超声诊断符合率约为98.21%(110/112).三者临床表现虽部分重叠但仍各具特征.15例附件扭转、25睾丸扭转及1例急性睾丸炎接受手术治疗,余均予以保守治疗.结论 客观、准确的急诊超声诊断报告,辅以全面深入的临床资料分析,可为小儿阴囊急症的诊疗提供重要帮助.     

小儿睾丸白血病的高频彩色多普勒超声诊断

目的:探讨小儿睾丸白血病的高频彩色多普勒超声表现.方法:回顾性分析经睾丸穿刺细胞学检查或病理组织学检查确诊的12例睾丸白血病的高频彩色多普勒超声图像特征.结果:12例睾丸白血病患者的超声图像中出现单侧或双侧睾丸增大的有11例,只有1例患者的睾丸无明显增大.10例患者双侧睾丸同时受累,2例患者单侧睾丸受累.7例患者受累睾丸的超声图像特征是睾丸回声弥漫性减低,且回声分布不均匀.5例患者的受累睾丸超声图像特征是睾丸内可见多个大小不等的低回声结节分布.其中有1例患者双侧附睾同时受累,表现为附睾肿大,其内可见多个低回声结节分布.4例患者双侧腹股沟淋巴结肿大.12例患者的彩色多普勒均表现为受累睾丸或附睾内血流信号明显增加.结论:结合临床资料,高频彩色多普勒超声在诊断睾丸白血病上具有一定的临床实用价值.     

彩色多普勒超声检查对小儿急性睾丸附件扭转的诊断及鉴别诊断价值

目的探讨彩色多普勒超声检查对小儿急性睾丸附件扭转的诊断及鉴别诊断价值。方法回顾性分析2010年1月至2012年1月上海市儿童医院收治的因急性阴囊肿痛而行彩色多普勒超声检查的262例患儿的超声声像图特征,并与手术病理、临床最终诊断结果相比较。结果 262例患儿最终诊断为急性睾丸附件扭转78例,超声诊断为小儿急性睾丸附件扭转76例,诊断符合率为97.43%(76/78),2例误诊为附件炎。78例患儿(100%,78/78)睾丸上极上方或睾丸上极与附睾头间见类圆形或椭圆形结节,呈高回声或低回声不等,内部回声不均匀,伴有患侧附睾头肿大;22例患儿(28.21%,22/78)患侧精索增粗;16例患儿(20.51%,16/78)伴睾丸肿大;11例患儿(14.10%,11/78)阴囊壁水肿。彩色多普勒血流成像示扭转的附件内均未见血流信号。78例急性睾丸附件扭转患儿左侧扭转54例,右侧扭转24例;其中32例接受手术探查,均手术切除,余46例接受保守治疗,治疗后症状、体征逐步改善、消失。急性睾丸扭转25例,超声诊断符合率100%(25/25),23例为完全扭转,2例不完全扭转。急性附睾炎56例,超声诊断符合率100%(56/56),右侧附睾炎30例,左侧附睾炎26例。腹股沟疝103例,超声诊断符合率100%(103/103),右侧腹股沟疝51例,左侧腹股沟疝39例,双侧腹股沟疝3例。结论彩色多普勒超声检查对小儿急性睾丸附件扭转具有较高的诊断及鉴别诊断价值,是临床首选的影像学检查方法。     

布氏杆菌性与非特异性睾丸附睾炎超声表现对比研究

目的：比较布氏杆菌性与非特异性睾丸附睾炎的二维和彩色多普勒超声表现。方法：布氏杆菌性睾丸附睾炎组（A组）和非特异性睾丸附睾炎组（B组）各30例患者。对两组患者均行阴囊超声波检查，检测指标包括受累侧睾丸体积、附睾头尾部厚度、阴囊积液、睾丸动脉收缩期峰值速度（PSV）、舒张末期血流速度（EDV）和阻力指数（RI）等，对两组数据进行比较。结果：两组睾丸体积、附睾头部和尾部厚度差异无统计学意义（P=0．906，0．106，0．129）。两组分别有25例和4例睾丸回声呈非均匀性减低，差异有统计学意义（P=0．000）。两组分别有27例和26例患者合并阴囊积液，其中A组24例积液透声差，B组为5例，差异有统计学意义（P±O．000）。A组睾丸动脉PSV和EDV明显快于B组（P=0．002、0．011），但两组间RI差异无统计学意义（P=0．751）。结论：布氏杆菌性睾丸附睾炎在超声上特异性表现为受累睾丸及附睾增大且回声呈非均匀性减低，阴囊积液透声差，睾丸动脉血流速度明显增快。据此可初步与非特异性睾丸附睾炎相鉴别。     

睾丸结核1例的超声表现

患者男,41岁.2个月前间断咳嗽,发热,最高达39 ℃,1个月前睾丸肿胀.彩超见:右侧睾丸、附睾实质性占位性病变.入院检查,结核菌素试验强阳性.胸片:两肺弥漫小结节影,左侧胸膜增厚,右上纵隔增宽.CT:两肺粟粒型结核,纵隔内示肿大淋巴结.腰穿:脑压正常,脑脊液化验:糖3.1 mmol/L,氯化物:118 mmol/L,蛋白质0.51个/L,细胞:3×106/L.支气管镜:支气管结核.入院后超声所见(图1、2):右睾丸42 mm×24 mm,形态规整,内回声不均匀,可见散在低回声区,大小4 mm×3 mm,呈粟粒状.附睾体尾交界处可见14 mm×12 mm强回声斑.右附睾尾内可见14 mm×12 mm低回声结节,血流丰富.左睾丸、附睾未见异常.左鞘膜积液.临床诊断:Ⅱ型肺结核、结核性脑膜炎、支气管结核、睾丸、附睾结核.经治疗后,手术切除睾丸,病理诊断:睾丸结核.     

Sonographic Findings of Tuberculous Vasitis

The purpose of this series was to describe the sonographic findings of tuberculous vasitis. We conducted a retrospective analysis of 3 cases of tuberculous vasitis. The following grayscale and color Doppler sonographic features were analyzed: location, echogenicity of the lesion, epididymal or testicular involvement, presence of hydrocele, and blood flow within the lesion. All 3 patients had focal (n = 2) or multifocal (n = 1) involvement of the scrotal segment of the vas deferens. The sonographic findings for tuberculous vasitis were heterogeneously hypoechoic in all of the cases. On color Doppler sonography, no blood flow was identified within the lesions of the vas deferens. All 3 patients had tuberculous epididymitis in addition to tuberculous vasitis. Tuberculous vasitis presents with infection along with tuberculous epididymitis, and it appears as a heterogeneously hypoechoic lesion in the scrotal segment of the vas deferens adjacent to the epididymal tail.     

Chronic tuberculous epididymitis: color Doppler US findings with histopathologic correlation

BACKGROUND: The aim of this study was to determine the color Doppler features of tuberculous epididymitis and to correlate these findings with histopathologic findings. METHODS: Color Doppler ultrasound (US) findings of 12 histopathologically proven tuberculous epididymitis and tuberculous epididymo-orchitis in 11 consecutive patients were retrospectively analyzed. Color Doppler US findings of tuberculous epididymitis were correlated with histopathologic findings. RESULTS: Color Doppler US findings of tuberculous epididymitis demonstrated no blood flow in the epididymal lesions except for focal linear or spotty flow signals in the peripheral portion. These findings correlated well with pathologic findings; the central portion of the epididymal lesions demonstrated granulomas with caseation necrosis, and the peripheral portion of the epididymal lesions had several medium to small vessels. CONCLUSIONS: Color Doppler US may be helpful for differential diagnosis of tuberculous epididymitis and non-tuberculous epididymitis.     

Differential diagnosis of focal epididymal lesions with gray scale sonographic, color Doppler sonographic, and clinical features.

OBJECTIVE: To determine whether focal epididymal lesions can be differentiated on gray scale sonographic, color Doppler sonographic, and clinical features. METHODS: This was a retrospectiveanalysis of 60 focal epididymal lesions in 57 patients. Focal epididymal lesions were classified into 3 groups: nonspecific epididymitis (n = 43), tuberculous epididymitis (n = 10), and benign epididymal masses (n = 7). The following gray scale sonographic, color Doppler sonographic, and clinical features were analyzed: size, location, echogenicity, and heterogeneity of the lesion; hypoechoic or hyperechoic rim presence; hydrocele presence; degree of blood flow in the lesion; patient's age; duration of symptoms; and scrotal tenderness. RESULTS: Lesions were larger in patients with tuberculous epididymitis than in those with either nonspecific epididymitis (P = .007) or benign epididymal masses (P = .0017). The hypoechoic or hyperechoic rim of the lesion was more common in patients with benign epididymal masses than in those with nonspecific epididymitis (P = .002). The degree of blood flow in the lesion was greater in patients with nonspecific epididymitis than in those with either tuberculous epididymitis (P = .0019) or benign epididymal masses (P < .001). The duration of symptoms was shorter in patients with nonspecific epididymitis than in those with either tuberculous epididymitis (P < .001) or benign epididymal masses (P = .0092). The frequency of scrotal tenderness was higher in patients with nonspecific epididymitis than in those with either tuberculous epididymitis (P < .001) or benign epididymal masses (P < .001). CONCLUSIONS: Gray scale sonographic, color Doppler sonographic, and some clinical features may be helpful for differential diagnosis of focal epididymal lesions.     

小儿阴囊急症的诊断和处理（附106例临床分析）

目的：探讨小儿阴囊急症的临床诊断和处理方法。方法：回顾性分析我院自1985-1999年收治的106例睾丸扭转、睾丸附件扭转和睾丸附睾炎的小儿阴囊急症病例。对其在病史、体征和彩色多普勒超声等方面进行统计学处理。结果：全部14例睾丸扭转均有睾丸触痛和提睾反射消失。有6例睾丸扭转患者通过彩色多普勒超声证实而手术,睾丸附件扭转88.9%有附睾触痛,85.2%有睾丸上极触痛以及37.0%有硬结,睾丸附睾炎90.8%有阴囊红肿,结论：体格检查在鉴别小儿阴囊急症中有显著作用。提睾反射的消失是睾丸扭转最敏感。最准确的体格检查表现。彩色多普勒超声在小儿阴囊急症的诊断中是一项有价值的辅助检查。如已明确或怀疑睾丸扭转,应尽可能早地施行探查手术。     

颈部淋巴结结核的CT影像表现

目的:探讨颈部淋巴结结核的CT影像表现及评价CT检查对颈部淋巴结结核疾病的诊断价值。材料与方法:回顾性分析90例颈部淋巴结结核的CT影像表现,40例行细针穿刺针吸活检确诊,43例行手术病灶清除病理检查确诊,另7病例经抗结核一年治疗治愈而证实。其中男54例,女36例,年龄1~74岁。所有的病例均行CT平扫,其中的67例做了增强检查。结果:颈部淋巴结结核的CT征象根据病理可分为四型:Ⅰ型:结核结节和肉芽肿形成,本组为12例;Ⅱ型:受累的淋巴结干酪样坏死,本组为21例;Ⅲ型:淋巴结包膜坏死,淋巴结互相黏连伴有淋巴结周围炎,本组为41例;Ⅳ型:干酪样物质破溃进入周围组织,形成脓腔,最终可通过窦道引流至皮肤表面,本组为16例,其中8例溃破形成窦道。以2~4型居多,约占87%。增强检查CT表现可以分为四型;1:均匀强化;2:边缘细环状强化;3:花环样强化;4:不均匀强化;各种增强类型可同时存在。病理分型与CT增强分型是对应的。结论:CT检查对面颈部淋巴结结核的诊断以及明确病灶范围具有重要的价值。     

结核性脑膜炎的MRI诊断分析

目的:分析结核性脑膜炎的MRI表现特征。方法:回顾性分析12例结核性脑膜炎患者的MRI表现。结果:MR平扫可发现5例位于基底池的脑膜病灶;增强扫描有11例脑膜异常强化,伴脑膜、脑内粟粒型结核灶,6例结核性室管膜炎2例,颅神经受损1例,轻度脑膜炎患者无脑膜异常强化1例。结论:活动性结核性脑膜炎的MRI主要表现为基底池的脑膜强化局灶性或弥漫性强化,以软脑膜-蛛网膜型强化多见,可伴脑膜、脑实质内粟粒型结核病灶。     

附睾炎的超声诊断

目的总结附睾炎高频彩色多普勒超声图像特征及超声对附睾炎的诊断价值。方法对55例经高频彩色多普勒超声检查并经手术、病理确诊的附睾炎患者的声像图资料进行回顾性分析。结果55例附睾炎中,慢性附睾炎36例、附睾精子肉芽肿性炎9例、急性附睾炎7例及附睾结核3例。其中2例附睾精子肉芽肿性炎和1例急性附睾炎误诊为附睾肿瘤。结论高频彩色多普勒超声结合临床资料综合分析,能准确诊断附睾炎。     

Gray-scale and power doppler sonographic appearances of acute inflammatory diseases of the scrotum

PURPOSE: We describe the spectrum of gray-scale and power Doppler sonographic appearances in inflammatory scrotal diseases. METHODS: Twenty-five patients ranging in age from 3 to 69 years underwent gray-scale and power Doppler sonography with multifrequency transducers of 7-9 MHz or 10-13 MHz. In addition, color Doppler and power Doppler findings were compared in 7 cases. RESULTS: In all 5 prepubertal patients, power Doppler imaging demonstrated hyperemia associated with epididymitis and, in some cases, orchitis. Among the 20 pubertal and adult patients, power Doppler imaging revealed increased vascularity associated with spermatic cord involvement, epididymitis, orchiepididymitis, or orchitis. Enlargement and heterogeneity of the epididymis and/or testis were seen in 11 patients, with vas efferens ectasia in 3 patients. Abscess formation and testicular infarction were easily depicted by power Doppler imaging. In 5 cases total, hyperemia was the only sonographic finding of inflammation. In the comparison between color and power Doppler imaging, a subjective increase in the number and length of vessels was seen with power Doppler imaging. CONCLUSIONS: Power Doppler imaging is an easy and fast Doppler modality for evaluating inflammatory conditions of the scrotum and proved especially useful in cases with no gray-scale sonographic anomalies, in prepubertal patients, and in patients with abscesses or ischemic lesions.     

附睾炎和附睾-睾丸炎的彩色多普勒诊断

目的：应用彩色多普勒诊断急性附睾炎、睾丸炎和慢性附睾炎,方法：81例急性附睾炎、睾丸炎和慢性附睾炎均进行了彩色多普勒检查,主要观察二维声像图和彩色多普勒血流图的特征并与健侧附睾和睾丸作对比。结果：75例是急性附睾炎,其中有5例同时伴有睾丸炎,6例是慢性附睾炎,71例有不同程度的鞘膜积液。附睾头部肿大,白膜明显增厚。彩色多普勒显示血流明显增加为诊断依据。结论：彩色多普勒诊断附睾炎或睾丸炎是一种十分有效的影像学诊断工具。