Pelvic and scrotal trauma: CT and triage of patients

Traumatic dislocation of the testicles was first reported during crush injury but is now more commonly related to motor vehicle accidents. Approximately 55 cases had been reported by 2003. Virtually no papers discuss the role of CT in the rapid diagnosis of penoscrotal trauma, although most polytrauma or “pelvic trauma” patients are rapidly evaluated by CT in the emergency room setting. As more patients with pelvic trauma are triaged and evaluated using CT scanners with greater multidetector capability, more patients will be seen with testicular injury. It is important for the emergency physicians, radiologists, and traumatologists not to overlook unsuspected cases of penoscrotal injury which are typically initially evaluated by history, physical exam, and ultrasound. We describe a recent case of initial diagnosis of bilateral testicular dislocation from blunt trauma using modern multidetector CT imaging technique.     

睾丸精原细胞瘤和淋巴瘤多普勒超声诊断及Logistic回归分析

目的 探讨彩色多普勒超声在睾丸精原细胞瘤和淋巴瘤鉴别诊断中的价值。 方法 选取睾丸肿瘤手术患者共80例,其中睾丸精原细胞瘤50例,睾丸淋巴瘤30例,均为单发病灶。运用?2检验比较两组组间的特点,用自变量X来表示有统计学意义的参数,因变量 Y来表示病理结果,按彩色多普勒超声设立模型并行Logistic回归分析。 结果 声像图特点中形态、边界、内部回声、无回声区、后方回声有统计学意义（P均<0.05)。回归模型具有统计学意义（P <0.05)。模型的灵敏度96.7%,特异度83%,准确率 70.1%。Logistic 回归模型的 ROC 曲线下面积为0.884。 结论 彩色多普勒超声对睾丸精原细胞瘤与睾丸淋巴瘤的鉴别诊断中具有较高临床应用价值。     

超声造影对闭合性睾丸损伤的诊断价值

目的 探讨超声造影在闭合性睾丸损伤诊断中的应用价值.方法 对33例可疑闭合性睾丸损伤患者进行常规超声及超声造影检查,检查结果与手术或随访结果对照.结果 33例患者中确诊睾丸损伤28例,常规超声、超声造影诊断的灵敏度分别为92.9％与96.4％,两者比较无差异性(x2＝0.5,P＝0.45＞0.05).超声造影对睾丸损伤分型的诊断符合率高于常规超声.结论 常规超声及超声造影检查均能对闭合性睾丸损伤做出较准确的定性诊断,超声造影比常规超声更有助于评价损伤的严重程度.     

Atlanto-occipital dislocation

Reported is the case of a 29-year-old woman who sustained an atlanto-occipital dislocation (AOD). This patient survived the initial resuscitation to expire some 72 hours later. Survival of patients with AOD is being reported with increasing frequency and with good neurologic recovery in many cases. Emergency physicians should be aware of this injury and the methods of initial evaluation and stabilization in order to maximize the potential for patients with these serious injuries. Radiographic features of AOD are outlined and the potential hazards of longitudinal traction are emphasized.     

Traumatic Testicular Dislocation after Minor Trauma in a Pediatric Patient

Background

Traumatic dislocation of the testicle is a rare injury that may result from blunt abdominopelvic trauma. The majority of cases reportedly occur in young adults secondary to severe scrotal trauma during high-speed motorcycle crashes. Our review of the available English medical literature revealed only one pediatric case.

Objective

We present a case of pediatric testicular dislocation and torsion resulting from minor abdominopelvic trauma. The case report is followed by a brief review of the available literature.

Case Report

A 10-year-old boy presented to the Pediatric Emergency Department with abdominal pain. He had suffered a strike to the abdomen and groin during an attempt at flipping over a “monkey bar” at school. A tender mass was found in his right inguinal canal and the genital examination revealed an empty right hemiscrotum. Bedside ultrasonography was used to locate the testicle and it was noted by color-flow Doppler to lack demonstrable blood flow. The patient was taken emergently to the operating room, where he underwent orchiopexy and hernia repair after a viable testicle was found. He had a subsequently uneventful recovery.

Conclusion

Although rare, testicular dislocation may be a serious result of abdominopelvic trauma. Emergency providers who care for trauma patients must include this condition in their differential diagnosis; to do otherwise risks a delay in diagnosis that may affect testicular viability. In this case, testicular dislocation may have resulted from the combination of trauma and a previously undiagnosed indirect inguinal hernia.     

彩色多普勒超声对阴囊闭合性损伤的诊断价值

目的探讨彩色多普勒超声对阴囊闭合性损伤的诊断价值。方法回顾性分析32例阴囊外伤患者的彩色多普勒超声图像资料,检测阴囊壁层次结构和睾丸的形态大小,内部有无肿块;对病变区,测量其大小,观察其形态、边界及内部同声,并用彩色多普勒观察肿块内部及周边血流情况。结果32例患者根据睾丸、阴囊的声像图表现可分为：睾丸挫伤5例,睾丸血肿10例,睾丸破裂16例,单纯阴囊壁血肿1例（另有10例阴囊壁血肿合并睾丸损伤）。结论高频彩色多普勒超声能准确诊断阴囊、睾丸的损伤,可作为阴囊闭合性损伤的首选检查方法。     

睾丸微小结石症的超声诊断与临床意义

目的 本通过对睾丸微小结石症超声诊断价值的研究、回顾相关献对其病理、声像图特点及临床常见伴发症进行讨论。方法 应用GE Logiq 500。百胜AU4彩超诊断仪。5-10MHz可变探头，选用表浅小器官软件系统。结果 16例患中，10例表现为双侧睾丸微小结石，6例为单侧。声像图表现为睾丸实质内弥漫分布针尖大小强光点，无声影。结论 睾丸微小结石症是一种较为罕见的疾病，因为它具有本身特有的声像图特点，所以不需要穿刺即可确诊，又因为其与睾丸肿瘤的发生有相关性及不孕症病率高，因此应用高频超声对其进行早期诊断和动态观察是十分必要的。     

晶状体脱位2例

例1,患者男,47岁,外伤后右眼视力明显下降3天.体检:右眼视力消失,有光感.右眼晶状体消失,眼压明显增高.超声所见:右眼长轴21mm,晶状体囊内晶状体结构消失,晶状体囊后壁破裂,晶状体整体脱落至玻璃体内,呈盘状强回声,略有漂浮感,玻璃体内见纵行强回声光带且与晶状体相连(为玻璃体膜);眼底未见异常回声(图1).超声诊断:右眼晶状体完全性脱位.     

螺旋CT在外伤性腕骨脱位或骨折-脱位诊断中的价值

目的探讨螺旋CT多平面重建在腕骨外伤性脱位、骨折并脱位中的诊断价值。方法回顾性分析48例经临床资料证实的腕骨脱位或腕骨骨折-脱位患者的临床、影像资料,分析X线检查、CT（包括轴位、MPR及VR重建）在腕关节脱位诊断中的价值。结果经临床随访确诊的48例患者中,多排螺旋CT诊断准确率为100%,X线准确率为70.83%,CT与X线在腕关节脱位的检出方面存在显著差异（χ²=4.5,P<0.05）。X线上漏诊的病例中,10例因未能发现舟骨、三角骨的细小骨折导致。本组中X线中4例误诊,其中以豌豆骨脱位误诊率较高。结论X线对于腕关节脱位发现率较高,但是对于腕骨细小骨折的发现能力不足,螺旋CT的MPR、VR重建能清晰显示腕骨移位、骨折等,为临床制定治疗方案提供影像学支持。此外,X线对于脱位存在误诊多与患者伤后处于被动姿态有关。     

睾丸微小结石超声诊断265例

目的 探讨睾丸微小结石声像图表现及男性疾病的相关性。方法 应用高频超声检查睾丸附睾，同时确定有无其他阴囊内疾病，了解其生育史。结果 声像图表现为睾丸实质内点状强回声，无声影。结论 睾丸微小结石对男性不育症无确切影响，与睾丸肿瘤无相关关系，属于常见、多发病，探头频率达13MHz可显著提高本病的检出率。     

Scapular dislocation

Isolated dislocation of the scapula is a rare entity encountered in the emergency department. Two mechanisms have been proposed, a distraction injury to the arm or direct trauma to the posterior scapula. With blunt trauma, a search for adjacent injuries should be performed. Radiographs, especially anterior oblique views, will demonstrate lateral displacement of the scapula. Acute presentations should be managed by closed reduction, whereas for those presenting later or if the diagnosis is not initially suspected, open surgical reduction may be required. A case is reported of 32-year-old man with a scapular dislocation, and the literature is reviewed.     

高频超声诊断成人阴囊闭合性损伤

目的 探讨高频超声在成人阴囊闭合性损伤中的价值.方法 对40例经手术病理及随访证实的成人阴囊闭合性损伤的高频超声表现进行回顾性分析.结果 成人阴囊闭合性损伤声像图表现可分为阴囊壁血肿(8例),睾丸挫伤(7例),睾丸血肿(7例),睾丸破裂(16例)和睾丸扭转(2例)五种类型.而血肿型可分为包膜下及睾丸内血肿,破裂型可分为部分破裂和完全破裂(碎裂)型.高频超声对阴囊闭合性损伤诊断准确率为97.5%(39/40).结论 高频超声不仅能对成人阴囊闭合性损伤准确诊断,而且对指导治疗有重要价值.     

Emergency Management of Blunt Testicular Trauma

Objective: Severe blunt testicular trauma is an infrequently reported consequence of injury, yet it is associated with significant sequelae. This case series evaluates the characteristics of patients with severe blunt testicular trauma, assesses the role of ultrasonography in their management, and offers an evaluation algorithm for use by both emergency and urology personnel.
Methods: A retrospective review was conducted of ten patients who had severe blunt testicular injuries referred for urologic evaluation over a seven-year period at a level 1 trauma center. Attention was focused on ultrasonographic results, operative findings, and testicular salvage rates.
Results: With the exception of two motorcycle crash victims, patients presented in a delayed fashion (mean 3.5 days; range 1–5 days). Most (6/10) patients had true testicular rupture, all were explored urgently, and there was a 100% testicular salvage rate. Of the eight patients who had preoperative ultrasonographic examination, two were reported to show testicular rupture, but on exploration only one in fact had a tunica albuginea tear. Six patients had ultrasonographic examinations that revealed nonspecific abnormalities but failed to show testicular rupture; three had testicular rupture.
Conclusions: Ultrasonography cannot be relied on to accurately diagnose rupture of the testis in high-risk patients. However, testicular rupture is universally associated with an abnormal ultrasonography scan, albeit commonly yielding nonspecific findings. A high level of suspicion is mandatory with high-energy transfer mechanisms. Since a significant delay in presentation is not unusual, early exploration is warranted in the setting of high risk and provides an excellent chance of testicular salvage. Injuries associated with normal testicular ultrasonography may be managed conservatively.     

Testicular tuberculosis in multidrug-resistant pulmonary tuberculosis

We report a rare case of multidrug-resistant pulmonary and testicular tuberculosis (TB) in a 25-year-old immunocompetent patient. The patient was suspected to have a testicular cancer. He underwent radical orchiectomy, and surgical pathology revealed a granuloma containing acid-fast bacilli in the testis. Bronchial washing fluid culture grew Mycobacterium tuberculosis resistant to isoniazid, rifampin, and ethambutol. To our knowledge, this patient represents the first case of testicular TB in multidrug-resistant pulmonary TB.     

Combined bilateral asymmetric hip dislocation and anterior shoulder dislocation

BACKGROUND:

Traumatic bilateral hip dislocation is a rare condition. Anterior shoulder dislocation combined with this condition is even a rare occurrence. A 57-year-old man had bilateral asymmetric hip dislocation with a posterior wall fracture of the left acetabulum associated with right shoulder anterior dislocation caused by falling down from a cherry tree. Traumatic hip dislocation and anterior shoulder dislocation represent a true orthopedic emergency.

METHODS:

Closed reduction was performed immediately for three of the dislocated joints. Posterior wall fracture of the left acetabulum was treated with open reduction and internal fixation by screws. Because of the severity of associated complications like aseptic necrosis or posttraumatic osteoarthritis, efforts were made to ensure prompt diagnosis, therapy and prognosis.

RESULTS:

The patient was successfully treated by open reduction and internal fixation of the left acetabulum, and discharged from the hospital.

CONCLUSION:

Traumatic asymmetric hip dislocation and anterior shoulder dislocation are an orthopedic emergency and early diagnosis with immediate reduction of the dislocation is the key determinants of excellent result of treatment.KEY WORDS: Trauma, Asymmetric hip dislocation, Shoulder dislocation, Immediate therapy     

Ultrasonography of the acute scrotum

The acute scrotum remains a difficult clinical challenge because of numerous etiologies including inflammatory processes, testicular torsions, traumas, and tumors that can justify early surgery. Ultrasound study appears to be the imaging modality of choice to confirm the clinical assessment. We reviewed 825 scrotal scans performed with high-resolution scanners; 283 were considered pathologic and classified as follows: 27 tumors (9.5%), 21 traumas including torsions (7.4%), 142 infectious diseases (50.1%), 99 dystrophic diseases (29.2%), and 16 miscellaneous (5.6%). Acute scrotal pain was the only symptom in 83 cases (29.3%). In this paper, we emphasize the different roles of ultrasound depending on the initial clinical presentation, which determines the clinician's questions. In the typical cases, ultrasound has a major role in the prognosis, as it allows evaluation of the severity of the lesions. On the other hand, in atypical cases, ultrasound has a decisive role in planning the management, which will be immediate surgery when sonographic findings highly suspicious for testicular torsion or acute ischemia of the testis are found. Based on our experience, we believe that ultrasound is a highly reliable modality for guiding medical or surgical treatment of an acute scrotum.