阴囊闭合性损伤的CT诊断价值

目的　探讨阴囊、睾丸闭合性损伤的CT诊断价值。方法　急性阴囊闭合性损伤 9例 ,作CT横断面平扫检查。结果　阴囊闭合性损伤CT表现为 :阴囊肿大 7例 ;肉膜增厚模糊 9例 ;鞘膜腔积液 4例 ;睾丸肿大、实质内出血 8例 ;睾丸白膜破裂 5例、白膜下血肿 2例 ;阴囊隔肿胀偏移 7例。结论　用CT横断面平扫检查急性阴囊闭合性损伤病人是一种精确诊断睾丸及其被膜损伤的影像学检查方法。     

MRI对阴囊闭合性损伤的诊断价值

目的 :探讨MRI对阴囊及其内容物闭合性损伤的诊断价值。方法 :对 11例急性、亚急性阴囊闭合性损伤患者 ,行MRSET1WI、FSET2 WI横断面、冠状面、矢状面扫描。结果 :阴囊增大皮肤增厚 9例 ,鞘膜积液 10例 ,白膜下血肿 3例 ,睾丸挫伤出血 8例 ,睾丸白膜破裂 3例 ,外伤后睾丸萎缩 2例。结论 :MRI是检查阴囊闭合性损伤 ,诊断睾丸受伤程度及疗效评价精确的影像学检查方法。     

彩色多普勒超声检查睾丸附件扭转的临床价值分析

目的探讨彩色多普勒超声在睾丸附件扭转诊断中的临床应用价值。方法对超声检查的睾丸附件扭转32例患儿影像学资料与病理结果进行对比分析。结果 32例患儿中,经彩色多普勒超声诊断为睾丸附件扭转者31例,诊断准确率为96.77%;超声误诊1例,1例误诊为附睾头结节,误诊率为3.23%。在睾丸与附睾头之间,或睾丸旁可见大小不等的圆形、椭圆形、斑片状、条索样结节,低回声或稍强回声,不伴声影,边界清晰,内部呈不均质网状回声。患侧阴囊壁增厚,附睾头肿大,与睾丸大小正常,睾丸鞘膜腔内少量积液。彩色多普勒血流显像示患侧附睾头血流信号较健侧明显增加;而睾丸旁结节内部无明显血流信号。结论彩色多普勒超声简便、无创、重复性好、准确率高,对睾丸附件扭转的诊断及其鉴别诊断具有重要的价值。     

双侧睾丸原发性非霍奇金淋巴瘤1例

患者男 ,72岁。于 1997年 8月无意中发现左侧睾丸无痛性肿大 ,1个月后行经腹股沟睾丸切除术 ,术后病理检查 :左睾丸弥漫型非霍奇金恶性淋巴瘤 ,中高度恶性 ,精索残端瘤细胞浸润。术后定期复查 ,并行放疗及ＣＨＯＰ方案化疗。于 2 0 0 0年 12月发现右侧睾丸无痛性肿大。体检 :全身表浅淋巴结不肿大 ,左腹股沟部见手术疤痕 ,左阴囊空虚 ,右睾丸附睾分界不清 ,质中 ,无触痛 ,表面未触及结节。右输尿管略增粗。超声检查提示 :右睾丸大小正常 ,右附睾尾增大 ,右睾丸鞘膜积液。肝胆胰脾及盆腔淋巴结未见异常。行经腹股沟睾丸切除术。术中见附睾头…     

因阴囊肿大发现布-加综合征1例

患者男,40岁。因阴囊肿大10余天到我院就诊。检查前暴露会阴部发现阴囊肿大十分明显（约正常阴囊大小5倍以上）,行彩超检查后发现阴囊壁水肿增厚（图1）,厚度约8 mm。双侧睾丸、附睾、精索未见明显异常。阴囊肿大的常见原因有：鞘膜积液、睾丸炎、附睾炎、     

急性闭合性睾丸损伤临床CT诊断

目的　探讨急性闭合性睾丸损伤临床CT诊断价值。方法　对 12例急性闭合性睾丸损伤临床及CT平扫检查进行分析。结果　睾丸轻度损伤肿大 1例 ,鞘膜下积血 1例 ,睾丸实质出血及白膜下血肿 2例。CT检查正确诊断睾丸碎裂 8例 ,正常结构消失 ,白膜中断 ,睾丸组织突出 ,睾丸碎片分离征象。结论　CT检查能准确诊断各种类型睾丸损伤 ,并能确定损伤的程度 ,为临床尽早提供可靠的诊断依据。     

闭合性阴囊损伤的CT诊断

目的确定闭合性阴囊损伤的ＣＴ诊断价值。方法 对２３例闭合性阴囊损伤的ＣＴ资料及临床处理进行回顾性分析。结果 根据睾丸失去正常的卵圆形结构，白膜中断，睾丸组织突出或睾丸断片分离等征象，ＣＴ正确诊断睾丸破裂８例；ＣＴ亦能显示阴囊壁血肿，鞘膜积血，白膜下血肿，睾丸实质血肿，睾丸附睾挫伤，精索及附睾血肿等其他病理改变。１７例手术探查证实ＣＴ显示的各种病理改变与手术病理完全相符。结论 ＣＴ能准确诊断各种类型     

高频多谱勒超声对阴囊病变的临床应用

目的:探讨阴囊病变的超声图像特征及对阴囊病变的临床应用价值。方法:应用高频探头对30例阴囊病变进行检查及诊断,睾丸肿瘤及睾丸破裂伤等经手术病理证实。结果:30例阴囊病变中,睾丸或精索鞘膜积液10例、隐睾2例、外伤2例、肿瘤2例、附睾炎8例、附睾肿瘤4例、腹股沟斜疝2例。结论:高频多谱勒超声检查对阴囊病变的诊断及鉴别诊断有极高的临床应用价值。     

左侧睾丸附件扭转超声表现1例

正患者男,11岁。晨起后突然左侧阴囊肿痛10h就诊。体检:左侧阴囊红肿,睾丸肿大,睾丸上方触及一1cm×1cm结节,触痛明显。超声检查:左侧睾丸及附睾明显肿大,睾丸上方见一8. 5m×4. 5mm高回声团(图1),包膜规则,内部回声均匀,未见明显血流信号。鞘膜腔见前后径9mm暗区,内透声差,阴囊壁明显增厚。超声诊断:左侧睾丸附件扭转伴     

急性阴囊疾病的彩色多普勒超声诊断

目的探讨彩色多普勒超声对急性阴囊病变的诊断与鉴别诊断价值。方法对急性睾丸炎、急性附睾炎、睾丸损伤、睾丸扭转及附件扭转52例急性阴囊疾病的彩色多普勒超声图像进行对比分析。结果本组急性阴囊疾病的超声检查结果与临床最后诊断及手术结果完全一致。本组52例中，急性睾丸炎10例，急性附睾炎16例，睾丸损伤12例，睾丸扭转9例以及睾丸附件扭转5例。结论彩色多普勒超声可作为诊断与鉴别诊断急性阴囊疾病的首选的无创临床检查手段。     

Novel method of using angioembolization for treating testicular hemorrhage after blunt trauma

Testicular or scrotal trauma is a rare form of trauma in the United States. Blunt trauma to the testicle can lead to testicular tunica albuginea rupture, testicle contusion, testicle hematoma, testicle torsion and epididymal injury. We report a case of a 48-year-old male patient who presented with right sided scrotal swelling and pain from a motorcycle collision. This turned out to be from a testicular rupture and resulting in a hematoma. The patient''s active bleeding from the right testicular artery was controlled by arterial embolization. Most reported cases of testicular artery bleeds are due to iatrogenic hemorrhage or non-traumatic injuries. Here, we report a rare case of testicular artery bleed due to a blunt trauma from a motorcycle collision. In conclusion, the testicular artery bleed was controlled successfully via testicular arterial embolization, making it a potential option for non-operative management for stable hemorrhage of the testicular artery.     

Imaging of the acute scrotum

The scrotum is a superficial structure and clinical examination is frequently not enough for making a specific diagnosis. In acute scrotal pain US can confirm the presumptive clinical diagnosis and provide additional relevant information. In testicular torsion, color-Doppler imaging has a central role since it has become possible to identify it at early stage by showing absence of perfusion in the affected testis before any gray-scale abnormality. Scintigraphy remains a satisfactory alternative in evaluating testicular torsion and should be used when color Doppler is inadequate, raising doubts about the suspected torsion. Diagnosis of torsion of testicular appendages is particularly difficult. Ischemic infarction shows a characteristic pattern at gray-scale and color-Doppler imaging, whereas hemorrhagic ischemia may require MRI. Inflammatory diseases of the scrotum can be easily investigated by echo color Doppler and conventional radiography, and CT can be particularly useful in the detection of gas bubbles. In scrotal trauma, scrotal hematoma, hematocele, intratesticular hematoma, and testicular rupture can be identified using gray-scale US with very good reliability. Magnetic resonance imaging is indicated when a small tear of tunica albuginea is suspected but not visualized on US. Received: 3 May 2000/Accepted: 8 June 2000     

Ultrasonography of scrotal trauma

Ultrasound has emerged as the diagnostic imaging modality of choice in the evaluation of patients with scrotal trauma. Most studies of testicular rupture show great accuracy with virtually no instances of false-positive or false-negative diagnoses. Ultrasonography is capable of differentiating between scrotal hematoma, extratesticular fluid collections, posttraumatic torsion testis, posttraumatic epididymitis, epididymal hematoma, as well as testicular rupture. The differentiation of hematocele from pyocele or exudative hydrocele is generally not possible. In patients with suspected testicular rupture, an accurate diagnosis followed by prompt surgical repair is the key to preservation of testicular function. Ultrasound is an extremely useful adjunct to the physical examination in cases of blunt scrotal trauma both for the differential diagnosis of the enlarged scrotum and for determining the necessity for emergency surgery.     

Ultrasonography of scrotal trauma

Ultrasound has emerged as the diagnostic imaging modality of choice in the evaluation of patients with scrotal trauma. Most studies of testicular rupture show great accuracy with virtually no instances of false-positive or false-negative diagnoses. Ultrasonography is capable of differentiating between scrotal hematoma, extratesticular fluid collections, posttraumatic torsion testis, posttraumatic epididymitis, epididymal hematoma, as well as testicular rupture. The differentiation of hematocele from pyocele or exudative hydrocele is generally not possible. In patients with suspected testicular rupture, an accurate diagnosis followed by prompt surgical repair is the key to preservation of testicular function. Ultrasound is an extremely useful adjunct to the physical examination in cases of blunt scrotal trauma both for the differential diagnosis of the enlarged scrotum and for determining the necessity for emergency surgery.     

Does color Doppler sonography improve the clinical assessment of patients with acute scrotum?

INTRODUCTION AND OBJECTIVES: Our experience concerning the use of color Doppler sonography (CDS) in the differential diagnosis of acute scrotum is reported. MATERIAL AND METHODS: From July 2000 to July 2005, 155 patients (median 17.2 years) were admitted with a diagnosis of acute scrotum (unilateral in 150 cases, bilateral in 5). Along with a careful anamnesis and the physical exam, all patients underwent a CDS study of the scrotal content using a sonograph GE Logiq 500 with a multifrequency (7.5-10 MHz) linear probe Small Part. The following CDS parameters were evaluated: intensity of the color-power signal on the testicular parenchyma and on the epididymis; systolic peak velocity (SPV) and telediastolic velocity (TDV) in correspondence of the gonadal hilum. Ultrasound and flowmetry parameters registered on the painful testis were compared with those registered on the healthy controlateral testis. The reduction/absence versus the increase of color-power signal in the parenchyma and the reduction/absence versus the increase of SPV and TDV in the centripetal intratesticular arteries were considered presumptive of testicular torsion versus orchiepididymitis. RESULTS: The results only refer to the 150 patients (300 testis) with acute monolateral scrotum. The clinical picture and the physical exam suggested a torsion of the spermatic cord in 40 cases, a spontaneous de-torsion in 5, an orchiepididymitis in 80, a blunt scrotal trauma in 15, a bulky epididymal cyst or a hydrocele in 4 and a testicular pain of unknown etiology in the remaining 6 cases. Standard US was pathological in 95 patients (63.3%); CDS was pathologic in 70 patients and in 42 of them suggested a testicular torsion. Fifty-three patients underwent surgical exploration: among 42 patients with a presumptive diagnosis of testicular torsion, the diagnosis was confirmed in 22 cases, no anomaly was found in 16 cases and in 4 patients a torsion of testicular appendix was found. The rupture of the tunica albuginea was present in six out of seven patients submitted to surgical exploration for previous blunt trauma and the sonographic diagnosis of hematocele was documented in all cases. The single false-negative diagnosis of testicular torsion in CDS occurred in an 18-month-old child. In presence of funicular torsion, the sensitivity and specificity of physical exam and CDS were 100% versus 95.7% and 86.5% versus 85.3%, respectively; sensitivity and specificity of SPV, TDV and color-Doppler signal on the testis were 100% and 94.8% versus 100% and 90.1% versus 95.7% and 90.8%. In the pre-operative assessment of scrotal trauma, the B-mode US showed a sensitivity and specificity of 100% and 90%, respectively; the color Doppler analysis has not supplied with additional elements for planning a surgical exploration. In presence of orchiepididymitis, the sensitivity and specificity of the physical exam in association to CDS was equal to 100%. In all patients with torsion of the testicular appendix, physical exam and CDS parameters were within normal limits. DISCUSSION AND CONCLUSIONS: In our experience CDS is an indispensable imaging modality for the clinical assessment of patients with acute scrotum; however, the informations it can afford are operator-dependent and have to be supported by the history and physical exam of the patient. CDS findings constitute probably an important medico-legal support when the necessity of surgical exploration is excluded; anyway, in presence of a clinical suspicion of testicular torsion, even with an apparently normal CDS, the surgical exploration is recommended.     

Comparison of tuberculous and pyogenic epididymal abscesses: clinical, gray-scale sonographic, and color Doppler sonographic features

OBJECTIVE: The purpose of this study was to evaluate the capability of clinical, gray-scale sonographic, and color Doppler sonographic features for differentiating tuberculous and pyogenic epididymal abscesses. MATERIALS AND METHODS: Retrospective analysis was performed in 10 cases of tuberculous epididymal abscess and in 13 cases of pyogenic epididymal abscess. The following clinical, gray-scale sonographic, and color Doppler sonographic features were analyzed: patient's age; duration of symptoms; scrotal tenderness; presence of sinus tract; concurrent tuberculosis in other organs; location, size, and echogenicity of the abscess; hyperechoic rim; testicular involvement; hydrocele; and blood flow in the epididymal lesion. RESULTS: Tuberculous epididymal abscess had a longer duration of symptoms (p = 0.0001) and a lower frequency of scrotal tenderness (p = 0.0048) than pyogenic epididymal abscess. The size of the abscess was larger in tuberculous epididymal abscess than in pyogenic epididymal abscess (p = 0.0002). The degree of blood flow in the peripheral portion of the abscess was lower in tuberculous epididymal abscess (p = 0.001). The patient's age, location and echogeninicity of the abscess, presence of sinus tract, hyperechoic rim, testicular involvement, and hydrocele did not differ between the tuberculous and pyogenic epididymal abscesses. CONCLUSION: Some clinical findings, gray-scale sonography, and color Doppler sonography were useful in differentiating tuberculous epididymal abscess from pyogenic epididymal abscess. The presence of long-term scrotal swelling without tenderness and a lower degree of blood flow in the peripheral portion of a large abscess are suggestive of tuberculous epididymal abscess.