Experimental study of the sonographic diagnosis of testicular torsion.

The sonographic and Doppler features of acute spermatic cord torsion were investigated in eight dogs. Serial sonography following torsion demonstrated unambiguous abnormalities in all experimental subjects within one hour. The observed abnormalities included increase in size of the spermatic cord, testis, and epididymis, decrease in echogenicity of the testis and epididymis, and loss of Doppler signal from the cord. Sonographic abnormalities were clearly visible before any histologic change was detected and well in advance of the onset of cellular necrosis. Since every experimental subject had an abnormal testicle, the identification of a normal testicle in a clinical setting is felt to exclude torsion. Combined gray-scale sonographic and Doppler features appear promising in the diagnosis of acute spermatic cord torsion and its distinction from acute epididymo-orchitis.     

Lymphoma of the spermatic cord: Sonographic appearance

Primary lymphoma of the spermatic cord is a rare disease accounting for about 1.6% of primary spermatic cord tumors. We hereby present a new case in which color Doppler ultrasound (US), contrast‐enhanced US, and MRI suggested a specific diagnosis that was subsequently confirmed pathologically. Color Doppler US revealed mostly hypoechoic, slighly hypervascular tissue surrounding the normal spermatic vessels, which was markedly hypervascular at contrast‐enhanced US. MRI showed diffuse infiltration by homogeneously enhancing tissue surrounding the spermatic vessels hypointense to testis on T2‐weighted images, isointense on T1‐weighed images, lacking fat tissue, with relatively high signal intensity on diffusion‐weighted images. © 2014 Wiley Periodicals, Inc. J Clin Ultrasound 42 :509–512, 2014     

Unusual masses in the spermatic cord: report of six cases and review of the literature.

Differential diagnosis of spermatic cord swellings includes direct inguinal hernia, hydrocele, spermatocele, hematocele, lipoma, tuberculosis, and filariasis. This communication focuses attention on other unusual swellings of the spermatic cord. Three cases of sarcoma, two cases of foreign body in the spermatic cord, and one case of vasitis are presented. Although unusual, these conditions should be considered in the differential diagnosis of spermatic cord swellings.     

彩色多普勒超声诊断精索病变的价值

目的探讨彩色多普勒超声在精索病变诊断与鉴别诊断中的价值。方法分别在阴囊、阴囊根部及腹股沟部进行超声扫查,观察精索径线的大小、声像图表现及血流情况。结果精索静脉曲张35例、精索炎36例、精索鞘膜积液25例及精索肿瘤3例,各有其声像图特征表现。结论彩色多普勒超声对于精索疾病的诊断与鉴别诊断,具有重要的临床价值。     

精索扭转的彩色多普勒超声诊断

为研究精索扭转的彩色多普勒超声（ＣＤＵ）表现及其诊断价值，采用彩色多普勒电脑声像仪对１３例精索扭转、１７例急性睾丸附睾炎及７２例正常睾丸进行检查。异常３０例中，１０例进行手术治疗，其余病例经随访得到诊断结果。ＣＤＵ诊断精索扭转敏感性为９２．３％，特异性为１００％。研究表明，ＣＤＵ能够发现精索扭转并评价其程度，可帮助临床医师迅速准确地作出诊断     

Neuroblastoma with spermatic cord metastasis in a child: sonographic findings.

We report a case of neuroblastoma in a patient who had no involvement of the spermatic cord at diagnosis but who developed spermatic cord metastasis 2 months later. The metastasis appeared on sonography as a hypoechoic, highly vascular, fusiform, hard, 14x10x7 mm mass located in the right inguinal canal and extending into the scrotum. The diagnosis of spermatic cord metastasis was confirmed by resection and histopathologic examination. We recommend that the scrotum and spermatic cord be evaluated by high-resolution sonography in children with neuroblastoma, both at the time of diagnosis and during follow-up.     

超声引导下注射聚桂醇硬化治疗精索鞘膜积液

目的探讨超声引导下注射聚桂醇硬化治疗精索鞘膜积液的治疗效果。 方法选择2012年5月至2014年12月鄂尔多斯市中心医院收治的超声诊断为精索鞘膜积液的患儿35例。超声引导下应用静脉留置针穿刺抽吸鞘膜积液,囊腔内注入聚桂醇注射液,保留5 min后全部抽出。1、3、6个月随访复查,评价疗效。一次治疗有效和无效的患儿给予再次治疗。仍无效者建议转手术治疗。治愈患儿继续随访精索有无增粗、变细、硬结等改变。 结果一次注射治愈31例（31/35,88.6%）,二次注射治愈3例（3/35,8.6%）。1例经二次治疗仍无效,转手术治疗。总治愈率97.1%（34/35）。治疗中患儿均无不适,治疗后随访腹股沟区未触及包块,与对侧精索对比,精索直径无增粗、变细等异常改变,精索周围无增厚膜状回声。 结论超声引导下注射聚桂醇硬化治疗精索鞘膜积液是一种高效的方法,可使绝大部分患儿避免手术治疗。     

精索副神经节瘤1例病例报告并文献复习

目的：提高对精索副神经节瘤的诊断和治疗认识。方法：报告我院2009年2月收治1例精索副神经节瘤患者,并复习文献。患者,男,66岁,因发现右侧阴囊上部包块20年入院。查体发现双侧精索静脉曲张,右侧阴囊上部占位,B超提示双侧精索静脉曲张,右侧阴囊上部34mm×28mm不均质包块,血供丰富。结果：行双侧精索静脉高位结扎及右侧精索包块切除术。术中见包块程球形、质中等、边界清楚。术后病检：副神经节瘤。1周后行扩切,未发现有肿瘤浸润。术后随访2月至今无复发及转移。结论：精索副神经节瘤诊断依赖于病检,良恶性判别尚无统一标准,治疗经完整切除肿瘤且术后需长期随访。     

不同程度精索扭转的超声诊断与临床对照分析

【目的】提高超声检查在精索扭转的诊断价值。【方法】分析50例经临床手术证实的不同程度精索扭转患者彩色多普勒超声图像特征。【结果】150例精索扭转患者中,48例因扭转程度不同,出现不同的精索二维声像图改变,40例彩色多普勒显像出现睾丸内血流改变异常,20例出现睾丸内二维声像图改变,敏感性分别为96％、80％、40％,特异性分别为100％、100％、67％。【结论】不同程度的精索扭转可出现不同的彩色多普勒超声改变,超声可作为临床首选的无创检查手段。     

Torsion of the spermatic cord: sonographic diagnosis

This article describes the ultrasound guidelines for evaluating patients with spermatic cord torsion, including gray-scale, Doppler with spectral analysis, and color and power Doppler sonography. The sonographic and Doppler features of acute, subacute, and chronic torsion of the spermatic cord are demonstrated and discussed.     

聚丙烯补片在腹股沟疝修补术中对输精管的影响临床研究

目的 探讨聚丙烯补片行腹股沟疝修补术对输精管的影响。方法 使用巴德公司生产SpomaTex补片进行疝修补，用来保护精索与输精管。结果 用SpomaTex补片与用普通补片行腹股沟疝修补的病人均未发现精索粘连及不育等并发症。结论 近期随访中，未发现精索粘连及不育等并发症，有待于长期各科合作的随访，国外已有聚丙烯补片引起不育的报道，应引起临床的高度重视。     

聚丙烯补片在腹股沟疝修补术中对输精管的影响

目的:探讨聚丙烯补片行腹股沟疝修补术对输精管的影响。方法:使用巴德公司生产SpomaTex补片进行疝修补,用来保护精索与输精管,并与同期单纯用聚丙烯平片行疝修补术的患者进行对比,观察二者对输精管的影响。结果:用SpomaTex补片与用普通补片行腹股沟疝修补的患者均未发现精索粘连及不育等并发症。结论:近期随访中,未发现精索粘连及不育等并发症,有待于长期各科合作的随访,国外已有聚丙烯补片引起不育的报道,应引起临床的高度重视。     

Myxoid liposarcoma of the spermatic cord: US and MR imaging findings

We report a patient with myxoid liposarcoma of the spermatic cord in whom combined use of both ultrasound (US) and MRI helped to suggest the diagnosis. The lesion was solid at US and vascularized at color Doppler. T1‐weighted MRI did not show fat within it; on T2‐weighted images it had high signal intensity, with a cyst‐like appearance. It is known that fat‐poor myxoid liposarcomas with high water content may mimic a cystic lesion on non‐contrast‐enhanced MR; then, a combination of MRI findings, suggesting a cyst, and of US findings, showing the mass was actually solid and vascularized, allowed preoperatively the diagnosis of fat‐poor myxoid liposarcoma. © 2013 Wiley Periodicals, Inc. J Clin Ultrasound 42 :96–99, 2014     

High-frequency color Doppler ultrasonography of the spermatic cord arteries: resistive index variation in a cohort of 51 healthy men.

OBJECTIVE: The purpose of this study was to determine the normal range of Doppler ultrasonographic measurements of spermatic cord arteries in a cohort of healthy men. METHODS: The spermatic cord arteries of 51 men were interrogated with color Doppler ultrasonography. The resistive index (RI) of each artery was measured for the entire cohort; peak systolic and end-diastolic velocity values were obtained in a smaller subgroup (n = 31). The artery with the lowest RI was labeled A; the other 2 arteries were identified as B and C. RESULTS: Three separate arteries were identified within the spermatic cord in all individuals. The median RI values for arteries A, B, and C were 0.70 (range, 0.48-0.82), 0.84 (0.67-0.90), and 0.84 (0.72-0.92), respectively. One-way analysis of variance showed a significant difference between the mean RIs of arteries A and B (P < .0001) and arteries A and artery C (P < .0001) but not between B and C (P = .49). Peak systolic and end-diastolic velocity values differed significantly between arteries A and B (P < .0001) and arteries A and C (P < .0001) but not between B and C (P = .31). No age effect was shown for the RI measurements of the cohort. CONCLUSIONS: Color Doppler ultrasonography enables the objective quantification of Doppler measurements of arteries within the spermatic cord. Knowledge of the normal range of Doppler measurements for spermatic cord arteries that supply the testes may be a useful adjunct to the assessment of the testes.     

保留睾丸引带和精索双向血供治疗小儿低位隐睾67例

【目的】探讨保留睾丸引带和精索血管对小儿低位隐睾治疗的疗效。【方法】选取B超报告睾丸位置位于腹股沟中下段,专科检查在腹股沟区能扪及睾丸的隐睾患者125例,其中A组67例采用经腹股沟皮纹横切口,保留睾丸引带和精索血管双向血供,B组58例患儿采用传统的腹股沟大斜切口,单纯保留精索血管,术后随访6月至1年。【结果】两组比较,A组手术时间、手术切口长度、术后睾丸血供、睾丸硬度明显较B组良好（P〈0．05）;术后睾丸的位置、复发、性激素水平两组无明显差异（P〉0．05）。【结论】采用经腹股沟皮纹横切口保留睾丸引带和精索血管血供治疗小儿隐睾创伤小,术后睾丸血供良好,手术时间缩短,术后切口瘢痕不明显,外形美观,疗效满意。     

实时精索团块在超声诊断睾丸扭转中的价值

目的 探讨实时精索团块在超声诊断睾丸扭转中的价值。方法 经超声检查的睾丸扭转患者42例,分析其阴囊的二维及彩色多普勒超声表现,仔细研究精索的走行,寻找有无实时精索团块。结果 所有病例均经手术证实。37例为完全扭转,二维及彩色多普勒上均可见精索团块,精索团块及其远端无血流信号。5例为不完全扭转,二维及彩色多普勒上均可见精索团块,精索团块内血流减少。结论 实时精索团块是诊断睾丸完全、不完全扭转最敏感、最特异的超声表现。     

Krukenberg tumor with concomitant ipsilateral hydronephrosis and spermatic cord metastasis in a man: A case report

BACKGROUNDTumors of the spermatic cord are rare, and approximately 25% are malignant neoplasms. Metastatic spermatic cord tumors are even rarer. Several studies have revealed that the most frequent primary tumors metastasizing to the spermatic cord and peritesticular tissues are neoplasms of the stomach and prostate. Furthermore, metastasis to the spermatic cord or epididymis may occur via retrograde lymphatic and hematic routes. We present the case of a man with gastric cancer that metastasized to the spermatic cord and epididymis, with concomitant ipsilateral hydronephrosis after surgical resection and chemotherapy for his primary tumor.CASE SUMMARYA 71-year-old man underwent total gastrectomy for pT4aN2 poorly differentiated gastric adenocarcinoma in December 2016. Two months after surgery, he received adjuvant chemotherapy with TS-1 from February 2017 to February 2018. Surveillance computed tomography (CT) was performed in June 2018, which did not reveal any sign of tumor recurrence. In November 2019, he presented with left lower quadrant abdominal pain and a palpable left inguinal-scrotal mass. CT revealed left mild hydronephrosis and a left scrotal mass measuring 4.0 cm × 1.7 cm. Tumor biomarkers, including alpha-fetoprotein (AFP), lactate dehydrogenase (LDH), beta-human chorionic gonadotropin (βHCG), carcinoembryonic antigen (CEA), and carbohydrate antigen 19-9 (CA19-9) were all normal. Renal and testicular echography showed left hydronephrosis and a left peritesticular soft tissue lesion with blood flow. Diagnostic ureteroscopy showed left lower ureter narrowing without an intraluminal lesion. A biopsy was obtained for the indurated spermatic cord and epididymis, which showed poorly differentiated adenocarcinoma. Immunohistochemical staining demonstrated that the tumor was diffusely and strongly positive for homeobox protein CDX2. The features were consistent with metastatic adenocarcinoma of a primary gastric tumor.CONCLUSIONIn patients with a history of primary cancer, an inguinal mass of unknown cause with accompanying ipsilateral hydronephrosis may be a sign of distant metastasis from a primary tumor, especially of gastrointestinal origin.     

彩色多普勒超声在精索扭转诊断鉴别诊断中的应用研究进展

在泌尿外科中,精索扭转是导致急性阴囊胀痛常见致病因素,在临床中极易出现漏诊及误诊情况。在以往的评估诊断中大多采用常规超声辅助检查,但该项检测不能够对微小血管及低速血流进行准确显示,进而不利于病情准确判定。彩色多普勒超声属于一种新型的超声检查技术,本研究通过对精索扭转患者采用彩色多普勒超声诊断,进而对其应用价值展开综述。     

Assessment of acute scrotum by Doppler color flow imaging: A report of four cases

We used an Aloka SSD-2000 ultrasound unit with a 5 MHz convex scanner to assess one case of torsion of the spermatic cord, one case of orchitis, and two cases of epididymitis. Color flow imaging showed absence of blood flow signals in the testis in the case of torsion of the spermatic cord, while blood flow signals in the scrotum were significantly increased in the cases of orchitis and epididymitis. Blood flow signals decreased after chemotherapy. Color flow imaging may thus prove useful in the diagnosis and follow-up of patients with acute scrotum.     

睾丸精索扭转的诊断与治疗（附18例报告）

目的：总结睾丸精索扭转的诊断及治疗方法。方法：回顾分析18例睾丸精索扭转患者的临床资料。患者年龄1～49岁,平均20.5岁,其中小于25岁者14例,占78%。左侧12例,占67%。发病至确诊时间5h-2周。结果：初诊误诊14例。18例均行手术治疗,5例扭转时间短,睾丸血运良好者手术后保留睾丸,13例因睾丸已坏死,行睾丸切除术。17例为鞘膜内扭转,1例为鞘膜外扭转。结论：彩色多普勒血流动态显象检查（CDFI）是急性精索扭转早期诊断可靠方法;手术探查是提高睾丸存活率的重要手段。