High-resolution real-time sonography of scrotal varicocele

Real-time sonography of the scrotal veins was performed in 13 subjects with clinically obvious or small varicocele and in 10 normal controls. In normals, the vessels were 0.5-1.5 mm in caliber and a main draining vein up to 2 mm often was seen. In all varicoceles, numerous dilated, tortuous, branching vessels of uniform size were observed. Vessels of different lesions varied in caliber from 2 to 5 mm. Blood flow was seen in some normal vessels, and sluggish flow was observed in all varicoceles. The direction of visualized flow and the influence on flow of the upright position and Valsalva maneuver were shown with confidence only in large and medium-sized lesions. In these the findings were consistent with incompetence of the internal spermatic venous system. The cystic spaces in multiloculated spermatoceles or epididymal cysts varied more in size, were not tubular or branching, and no flow phenomenon was seen at high gain settings. Sonography provides an alternative to other noninvasive tests for detection of a small varicocele, especially in the infertile patient.     

High-resolution sonography of scrotal contents in asymptomatic subjects

Forty male volunteers with no known intrascrotal pathology by history and physical examination were scanned with a 10-MHz dedicated superficial-parts scanner. Sonographic features of intrascrotal anatomy were reviewed. The testes appeared homogeneous in texture and occasionally contained cysts (8%). The echogenic head of the epididymis, although variable in size and shape, was consistently imaged. Epididymal cystic structures (29%) and calcifications (3%) were occasionally seen. The amount of peritesticular fluid, presence of variococeles , and range of scrotal skin thickness were also noted. An understanding of intrascrotal anatomy in asymptomatic subjects can provide a baseline for the evaluation of the symptomatic scrotum.     

Acute scrotal abnormalities in children: diagnosis by combined sonography and scintigraphy

Both scintigraphy and real-time sonography have been used to assess acute symptoms involving the scrotum. However, because of its high sensitivity and ability to document physiologic abnormalities, scintigraphy has been the procedure of choice. Scintigraphy, however, lacks specificity; its value lies mainly in serving to distinguish torsion from nontorsion. The purpose of this study was to supplement scrotal scintigraphy with sonography to determine if the combination improves diagnosis and management compared with scintigraphy alone. Forty-three scrotal scintigrams and sonograms were performed on 40 consecutive patients with acute scrotal symptoms. The interpretation of the scintigram was altered by sonography in six (14%) of the combined scans, directly affecting clinical management. In three patients with acute hydroceles diagnosed by sonography, exploratory surgery was avoided despite scintigraphic findings suggesting testicular torsion. Scintigraphy was normal in two patients with spontaneous testicular detorsion, whereas sonography showed recent spermatic-cord torsion that required subsequent orchiopexy. In a patient with epididymitis and orchitis, sonography showed a complicating scrotal abscess, which was not apparent on scintigraphy and which required antibiotic treatment. The addition of sonography to the scintigraphic evaluations of children with acute scrotal abnormalities changed the diagnosis and clinical management in 14% of the patients studied.     

彩色多普勒超声在急性阴囊肿痛诊断中的应用

目的评价彩色多普勒超声(CD)在急性阴囊肿痛诊断及鉴别诊断中的应用价值。方法应用CD对53例急性阴囊肿痛患者进行急诊检查。观察阴囊内容物的形态、回声、结构及血流变化。经手术或临床治疗随访证实诊断。结果53例阴囊急症中,37例经非手术治疗及超声随访证实诊断,16例经手术及病理确诊。CD诊断准确率98%(52/53)。其中,睾丸扭转92%(12/13),睾丸、附睾炎100%(28/28),阴囊外伤100%(9/9),阴囊皮肤感染100%(3/3)。结论CD不仅能够区别睾丸扭转和炎症,并能鉴别肿瘤与炎症,还可评价阴囊外伤的程度及预后,因而它可作为诊断急性阴囊肿痛的首选方法。     

Testicular microlithiasis: prevalence and tumor risk in a population referred for scrotal sonography

OBJECTIVE: Considerable accrued evidence points to an association between testicular microlithiasis, intratubular germ cell neoplasia, and testicular tumor. This study assesses both the prevalence of testicular microlithiasis revealed on sonography in a referred population and the concurrent tumor risk. MATERIALS AND METHODS: Over a 32-month period (April 1996 through November 1998), 4892 scrotal sonographic examinations were performed in 4819 patients at four referral centers. All patients underwent high-resolution (7- to 10-MHz) imaging. Using a computerized word search (n = 4102; testicular microlithiasis, calcification, microliths, calcific foci, tumor, neoplasm, cancer, hyperecho, hypoecho, heterogen, and carcinoma) and manual retrieval (n = 790), cases of tumor, testicular microlithiasis (>5 microliths per sonogram), and testicular microlithiasis plus tumor were pulled and retrospectively reviewed. The presence and type of tumor were confirmed at histology after orchidectomy. RESULTS: Fifty-four tumors were found among 4892 scrotal sonograms (28 seminomas, 14 teratomas, 8 mixed germ cell tumors, 2 Leydig cell tumors, and 2 non-Hodgkin's lymphomas). Testicular microlithiasis was present in 33 patients, giving a prevalence of 0.68%. Concurrent tumor and testicular microlithiasis were detected in seven patients, a relative risk of tumor in testicular microlithiasis was 21.6-fold (95% confidence limits: 10. 6-fold, 44.2-fold). In one patient with testicular microlithiasis, a previous orchidectomy for mixed germ cell tumor had been performed (not included in the relative risk calculation). CONCLUSION: In a referred population of 4819 patients the prevalence of testicular microlithiasis was 0.68% and the relative risk of concurrent tumor was 21.6-fold. Sonographic surveillance of testicular microlithiasis cases for tumor is mandatory.     

高频超声对睾丸微石症与睾丸肿瘤间的关系初步探讨

目的探讨睾丸微石症与睾丸肿瘤的关系。方法回顾分析2003年1月～2011年12月我院门诊及住院12956例患者的阴囊超声检查资料。参考国外的标准对睾丸微石症(TM)进行分级,将其分为局限型TM(LTM)和典型的TM(CTM),其中又将CTM分为Ⅰ级、Ⅱ级和Ⅲ级。结果①所有患者中共检出睾丸微石症277例,检出率2.14%(277/12956);单侧病变34例(占12.3%),双侧病变243例(87.7%)。LTM有62例(22.4%),CTM型中Ⅰ级92例(33.2%),Ⅱ级68例(24.5%),Ⅲ级55例(19.9%);②检出睾丸肿瘤52例,检出率0.40%(52/12956)。277例睾丸微石症患者中合并睾丸肿瘤19例,发生率6.9%(19/277),而在12679例无睾丸微石症者中仅33例合并睾丸肿瘤,发生率0.3%(33/12679),睾丸微石症患者的睾丸肿瘤发生率明星高于无微石症者(P<0.01)。但不同级别睾丸微石症的睾丸肿瘤发生率差异无统计学意义(P>0.05)。结论睾丸微石症与睾丸肿瘤的发生具有一定的相关性,但不同级别睾丸微石症的睾丸肿瘤发生率无差异。     

Unusual scrotal mass and review of scrotal imaging

Asymptomatic painless testicular swellings are not uncommon. The differential diagnosis of scrotal mass includes cysts, lipomas, hydrocele, varicocele, benign and malignant testicular masses. Prompt clinical examination followed by appropriate imaging is the key to early diagnosis and appropriate management. Our case is that of a self-neglected, long standing partially ruptured benign epidermal inclusion cyst masquerading as a massive painless scrotal mass. Magnetic resonance imaging not only displays the size and margins of these lesions, but also shows characteristic internal features that may suggest the preoperative diagnosis. We report a case of unusually large cystic scrotal extratesticular epidermal inclusion cyst, illustrate the imaging characteristics and discuss the differential diagnoses.     

核素显像在阴囊急症的临床应用价值

目的 探讨放射性核素阴囊显像在急性睾丸扭转与急性睾丸附睾炎鉴别诊断中的临床应用价值。方法 对阴囊急症13例行SPECT核素阴囊显像，“弹丸”注射^99mTcO^-4 370 MBq后即刻行动态血流灌注显像，15min后行静态血池显像并进行显像结果分析。结果 10例血流灌注相呈血流减低，静态血池相放射性缺损，经急诊手术证实了9例为睾丸扭转，其中3例因及时确诊及手术纠正扭转而保留患睾。3例血流灌注相呈血流增高，静态血池相放射性分布仍明显高于对侧，符合睾丸附睾炎表现．经内科保守治疗后症状消失。结论 睾丸缺血的时间是影响其存活的重要因素。核素阴囊显像简便、快速、非创伤，对阴囊急症的鉴别诊断、治疗方法的选择具有重要的临床指导价值。     

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.     

Pitfalls in scrotal echotomography

We reviewed 500 scrotal sonograms with a gray-scale equipment using a 7 Mega Hertz transducer. 7 cases are presented in which there are the two principal traps which must be avoided in the practice of scrotal ultrasound: To find as pathological, some scrotal or parascrotal structures which are anatomical. To confuse pathological images. These diagnostic problems are almost resolved by three conditions: A perfect knowledge of normal ultrasound anatomy, a good experience of the operator in this scope and a strict management of the ultrasonic investigation. There, the scrotal sonogram is highly reliable.     

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.     

Comparison of fundamental sonography, tissue-harmonic sonography, fundamental compound sonography, and tissue-harmonic compound sonography for focal hepatic lesions

Image qualities of fundamental, tissue-harmonic, fundamental compound, and tissue-harmonic compound sonography for evaluating focal hepatic lesions were compared. Two radiologists, blinded to the type of techniques and to the final diagnosis, independently evaluated 384 images of 96 hepatic lesions: hemangiomas (n=35), hepatic cystic lesions (n=28), cirrhosis-related nodules (n=22), focal nodular hyperplasia (n=1), and metastases (n=10). All images were graded in terms of lesion conspicuity, margin sharpness, and overall image quality using a 4- or 5-point scale. In the cases of cystic lesions, posterior acoustic enhancement and internal artifacts were also analyzed. A Friedman test was used for multiple statistical comparisons of the four techniques for all parameters. Compound imaging was significantly superior to fundamental imaging regarding lesion conspicuity, margin sharpness, and overall quality (P<0.05). For posterior enhancement and internal artifacts within the cyst, harmonic ultrasonography (US) was significantly better than fundamental US (P<0.05). For evaluating focal hepatic lesions on US, compound imaging provided better lesion conspicuity, better margin sharpness, and better overall image quality than fundamental imaging did. Tissue harmonic imaging also provided better posterior enhancement and fewer internal artifacts of the cyst than fundamental imaging.     

Biliary sonography

Ultrasonography is a dynamic, powerful, and readily available tool in the armamentarium of biliary diagnosis. The use of this modality is indicated in the initial work-up of jaundice since ultrasonography is exquisitely sensitive to the presence of intrahepatic or extrahepatic biliary dilatation. The liver and pancreas may be screened for focal masses. In acute right upper quadrant pain, ultrasonography can assess the organs residing in this area, often yielding significant information in the diagnosis of gallbladder disease. Newer modalities such as color Doppler may add specificity and reliability to sonographic findings.     

Asymptomatic scrotal masses in children

The ultrasound scans of 16 boys with asymptomatic scrotal masses were retrospectively studied. Ultrasound localized seven of the masses as primary testicular lesions and nine as extratesticular lesions, six of which were hydroceles. Ultrasonography also characterized the scrotal masses as predominantly cystic or solid. Ultrasound could not differentiate benign from malignant disease when a solid mass was found. When a hydrocele was identified, ultrasound was able to image the underlying testis and accurately evaluate it for primary disease. These ultrasound observations can help the surgeon decide when to explore the scrotum and whether to approach the testes via an inguinal or scrotal incision. Conversely, ultrasonographic confirmation of a normal testis may prevent needless surgery and the removal of a normal testis.     

Ultrasound of the scrotal contents

The technique, interpretation, and clinical applications of scrotal ultrasound are examined. The sonographic appearance of the normal scrotal contents and commonly encountered pathologic conditions are illustrated. A clinically-useful classification of scrotal pathology is based on ultrasound’s ability to anatomically localize scrotal pathology into 1 of 3 categories: extratesticular, testicular, or combined extratesticular and testicular. Prognostic and management decisions may be made on the basis of this classification.