超声多普勒检查在阴囊急症中的应用

目的 探讨阴囊急症的彩色多普勒血流显像（CDFI）和彩色多普勒能量图（CDE）特征及其鉴别诊断。方法 用CDFI和CDE观察64例阴囊急症病灶区血供状况,并与健侧比较。对37例急性附睾炎及睾丸炎的附睾动脉和3例早期睾丸扭转的睾丸内动脉的血流参数进行检测,并与30例正常人对照。结果 45例急性附睾炎及睾丸炎中37例表现为高血供,附睾内血流速度明显高于正常对照组,阻力指数低于正常对照组（P〈0．01）;5例病变侧睾丸无血供或低血供,睾丸内血流阻力指数增高,超声诊断睾丸扭转,与手术病理诊断相符;3例睾丸附件扭转,附件内无血流信号显示,而附着处组织血供增多;11例阴囊外伤中,睾丸完全破裂1例,部分破裂2例,挫伤5例,单纯血肿3例。结论 CDFI和CDE可准确地鉴别睾丸扭转、睾丸附件扭转和炎症,有助于睾丸损伤的临床治疗方案的选择,可作为阴囊急症诊断的首选检查方法。     

Ultrasound in the assessment of the acute scrotum

Color Doppler imaging (CDI) has become the study of choice in evaluation of the scrotum due to technological advances resulting in superior resolution and sensitive Doppler systems. CDI has become particularly helpful in evaluating the scrotum in the setting of acute disorders, such as torsion of the spermatic cord, epididymal and testicular inflammation, and scrotal trauma. CDI should be the study of choice to evaluate for torsion of the spermatic cord and demonstrates a high degree of accuracy. CDI in such a setting, however, does require operator experience, sensitive Doppler ultrasound equipment, and operator knowledge of the limitations of CDI. With epididymitis or epididymo-orchitis, CDI has proven to be quite helpful in evaluating the scrotal contents for the presence of inflammation and associated complications. In scrotal trauma, CDI's utility remains somewhat controversial, but with further investigation its appropriate application in this situation may become clear. © 1996 John Wiley & Sons, Inc.     

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。     

Sonographic differential diagnosis of acute scrotum: real-time whirlpool sign, a key sign of torsion.

Objective. The purpose of this study was to prospectively investigate the role of high‐resolution and color Doppler sonography in the differential diagnosis of acute scrotum and testicular torsion in particular. Methods. Patients who underwent sonography for acute scrotum between April 2000 and September 2005 were included in the study. Gray scale and color Doppler sonography of the scrotum was performed. The spermatic cord was studied on longitudinal and transverse scans from the inguinal region up to the testis, and the whirlpool sign was looked for. Results. During this period, 221 patients underwent sonography for acute scrotum. Sixty‐five had epididymo‐orchitis with a straight spermatic cord, a swollen epididymis, testis, or both, an absent focal lesion in the testis, and increased flow on color Doppler studies along with the clinical features of infection. Three had testicular abscesses. Sonography revealed features of torsion of testicular appendages in 23 patients and acute idiopathic scrotal edema in 19. Complete torsion was seen in 61 patients who had the whirlpool sign on gray scale imaging and absent flow distal to the whirlpool. There was incomplete torsion in 4 patients in whom the whirlpool sign was seen on both gray scale and color Doppler imaging. Nine patients had segmental testicular infarction, and 1 had a torsion‐detorsion sequence revealing testicular hyperemia. In 14 patients, the findings were equivocal. There was a complicated hydrocele, mumps orchitis, and vasculitis of Henoch‐Schönlein purpura in 1 patient each. Five patients had normal findings. Fourteen were lost for follow‐up. Conclusions. Sonography of acute scrotum should include study of the spermatic cord. The sonographic real‐time whirlpool sign is the most specific and sensitive sign of torsion, both complete and incomplete. Intermittent testicular torsion is a challenging clinical condition with a spectrum of clinical and sonographic features.     

The acute scrotum

In boys and adolescents, the acute scrotum usually results from one of three diseases: torsion of the spermatic cord, torsion of the appendix testis, or epididymitis. A rapid diagnosis of torsion of the cord, if present, is essential, and as soon as this diagnosis is made, arrangements must be made for timely surgical correction. Although a diagnosis for the acute scrotum in this age group can sometimes be made on the basis of the history, pathognomonic signs, and basic laboratory analysis of the urine and a urethral discharge, in the usual case diagnosis requires a Doppler ultrasound examination (which if positive for torsion makes the diagnosis), a radionuclide scan (for cases negative or indeterminate for torsion on the Doppler examination), or, as a last resort, scrotal exploration. In men, by far the most common cause of the acute scrotum is epididymitis, with the torsions being much less common. In heterosexual young men with epididymitis, N. gonorrhoeae and C. trachomatis are the most likely etiologic organisms; in homosexual men and older men (and boys), E. coli, Pseudomonas sp., and the gram-positive cocci are the most common pathogens. Ceftriaxone plus tetracycline is the initial antimicrobial regimen of choice in heterosexual young men; in the absence of evidence of a sexually transmitted pathogen, one of the antimicrobials effective against common urinary tract pathogens is the initial antimicrobial of choice in all other patients. When torsion of the cord is suspected in adult male patients, the Doppler examination and the radionuclide scan (if the Doppler is negative or indeterminate) can again make the diagnosis or rule it out.     

Torsion of the spermatic cord: the main gray-scale and doppler sonographic signs

Scrotal ultrasonography (US) is usually the initial imaging modality for evaluating patients who present with acute pathologic conditions of the scrotum. Acute epididymitis, acute epididymo-orchitis, torsion of the spermatic cord (TSC), and other acute scrotal abnormalities may have similar findings at clinical examination. Pain and swelling make the clinical examination difficult, sometimes practically impossible, potentially resulting in management delays. The objective of this review is to summarize the main clinical signs of the TSC and to illustrate and briefly discuss the US features of this entity, including gray-scale imaging, color Doppler with spectral analysis, and power Doppler sonography. Although TSC can occur at any age, it is most common in adolescent boys. The intensity of the symptoms and the US findings vary with the duration of the torsion, number of twists in the spermatic cord (degree of rotation), and how tightly the vessels of the cord are compressed. An enlarged, more spherical, and diffusely hypoechogenic testis without detectable arterial and venous testicular flow at color and power Doppler US is considered diagnostic of acute testicular ischemia. The presence of a color or power Doppler signal in one part of the testis does not exclude TSC. Positive blood flow but significantly diminished, usually near or inside the mediastinum, may be found, mainly in the partial or incomplete TSC. Identification of a large echogenic extratesticular mass distal to the site of the torsion, frequently misinterpreted as a chronic epididymitis, can be the key to the diagnosis of TSC. When a small arterial sign is found a low amplitude waveform is present with an increased resistive index on the affected side due to a diminished, absent, or reversed diastolic flow. Gray-scale imaging, color Doppler, power Doppler and pulsed Doppler with spectral analysis are very effective to make or exclude the diagnosis of TSC.     

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。     

Testicular ultrasound

Acute scrotal pain makes up approximately 0.5% of all complaints presenting to an emergency department. Some of the most com-mon diagnoses for this complaint are testicular torsion and epididymitis. Misdiagnosing testicular torsion can lead to organ loss,cosmetic deformity, and compromised fertility. Modem ultrasound examination of the scrotum is the test of choice for acute scrotal pathology and yields high accuracy compared with surgical exploration. A key component of the testicular examination is use of power and spectral Doppler ultrasonography. Examination of the acute scrotum should not be undertaken unless Doppler capability is available because the evaluation of blood flow is such an important part of diagnosis of testicular torsion, orchitis, epididymitis,trauma, and hemorrhage into a mass.     

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.     

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。     

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。     

彩色多普勒超声诊断急性附睾、睾丸炎的价值

目的探讨彩色多普勒血流显像对急性附睾、睾丸炎的诊断价值。方法正常组与病变组对比观察二维声像图表现、血流信号的多少、血流速度、RI、S／D比值，并进行统计学处理。结果病变组急性睾丸炎15例，急性附睾炎63例与正常组30例比较有较特征性的声像图表现，各项测值有显著的差异。结论彩色多普勒超声诊断急性附睾、睾丸炎具有较可靠的临床价值。     

阴囊急性炎症的彩色多普勒超声表现及其评价

目的进一步探讨阴囊急性炎症的彩色多普勒超声（ＣＤＵ）表现并评价其临床应用价值。方法应用ＣＤＵ对５２例阴囊急性炎症进行检查,观察阴囊内容物的形态、回声及血流变化,并通过手术及临床治疗随访证实诊断。结果ＣＤＵ诊断符合率为９８％,其中睾丸炎为９１％（１０／１１）,炎症并肿瘤６７％（２／３）,附睾炎（２１）、睾丸附睾炎（９）、精索炎症（４）和阴囊壁感染（５）均正确诊断。结论本文资料表明,ＣＤＵ能够诊断急性睾丸附睾炎,了解急性炎症的预后,并对其疗效作出评价;还可帮助鉴别急性睾丸炎或是睾丸扭转、局灶性炎症或是肿瘤。     

超声对阴囊病变的诊断价值

目的 探讨阴囊病变的超声图像特征及超声对阴囊病变的诊断价值。方法 应用高频探头对96例阴囊病变进行检查并诊断，睾丸肿瘤等经手术、病理证实。结果 56例睾丸病变中，肿瘤29例、炎症6例、扭转4例、外伤5例、隐睾12例；8例附睾病变中，炎症5例、结核3例；精索静脉曲张21例；腹股沟斜疝11例。超声对阴囊病变的阳性诊断符合率为100％。结论 超声检查对阴囊病变的诊断及鉴别诊断有极为实际的应用价值。     

新生儿睾丸扭转的超声诊断特征并文献复习

目的探讨新生儿睾丸扭转的超声诊断特征。 方法回顾性分析成都市妇女儿童中心医院泌尿外科于2019年5月8日收治的1例睾丸扭转患儿的临床资料,对超声检查睾丸的位置、大小、形态、回声、血流等图像资料进行分析,并复习相关文献。 结果患儿出生6 h后无明显诱因出现哭吵,右侧阴囊肿胀,皮肤明显青紫,有触痛,以阴囊上部明显,抬举时疼痛无明显变化,透光实验见阴囊内有积液,右侧腹股沟精索走行区有轻度压痛,左侧阴囊未查及明显异常。超声表现：右侧睾丸实质欠均匀,可见放射状无回声,实质内未探及明显血流信号,右侧附睾头增厚,回声欠均匀,可见线状无回声,右侧睾丸鞘膜腔内无回声;左侧睾丸实质回声均匀,血流分布未见明显异常,左侧附睾未见明显异常。右侧精索增粗,回声欠均匀,内可见点状血流。超声提示右侧阴囊睾丸扭转可能。 结论通过超声检查能够对新生儿睾丸扭转进行准确的诊断,有利于为患儿的治疗提供准确依据。     

彩色多普勒超声对睾丸附件扭转的诊断价值

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 回顾性分析我院经手术或临床随访证实的35例睾丸附件扭转患者的声像图资料.结果 所有患者均可在睾丸上极与附睾头附近探及一非均质高回声结节,结节内未探及血流信号;22例患者同时伴有同侧睾丸及附睾轻度增大,且彩色多普勒血流信号较对侧相对增多;24例患者伴有同侧精索增粗;...     

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     

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。     

彩色多普勒超声对腹股沟区包块的诊断价值

目的探讨彩色多普勒超声对腹股沟区包块的诊断价值。方法回顾性分析经手术和病理证实或随访的53例腹股沟区包块的声像图资料,通过观察其二维声像图及彩色多普勒血流成像,分析包块的声像图特点及鉴别要点。结果 53例患者中腹股沟疝18例,声像图表现为与腹腔相通的无～强回声;鞘膜积液14例,声像图表现为无回声;肿大的淋巴结6例,声像图表现为椭圆形或圆形低回声;隐睾4例,声像图表现为椭圆形低回声,患者同侧阴囊内睾丸缺如;实性肿瘤3例,声像图表现为扁圆形低或等回声;血肿2例,声像图表现为不均匀低回声;精索炎2例,声像图表现为较健侧精索明显增粗且血流丰富;精索静脉曲张2例,声像图表现为网状无回声;子宫圆韧带囊肿1例,声像图表现为椭圆形无回声;蔓状血管瘤1例,声像图表现为不规则无回声,探头适当加压内见丰富血流。结论彩色多普勒超声对腹股沟区包块具有较高的诊断价值,可为临床诊疗提供可靠依据,应作为临床首选的检查方法。     

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。