彩色多普勒超声在阴囊急症中的应用

应用彩色多普勒超声（ＣＤＳ）评价３７例急性阴囊疼痛患者。采用直接探测法及低速血流设置。与健侧阴囊ＣＤＳ表现相比较，将患侧阴囊ＣＤＳ结果分为正常血流灌注、低血流灌注、无血流灌注和高血流灌注。结果显示：以睾丸内无血流灌注诊断睾丸扭转５例，敏感性和特异性均为１００％。以睾丸和附睾内高血流灌注诊断睾丸炎及附睾炎的敏感性为８３．３％，特异性为１００％，准确性为８９．２％。表明ＣＤＳ可准确地区分睾丸扭转和炎症，是一种评价急性阴囊肿瘤准确可靠及临床价值较高的方法     

高频超声、彩色血流图及能量图在阴囊急症诊断中的临床价值

目的 探讨应用高频超声、彩色血流图及能量图在阴囊急症诊断中的临床价值。方法 选择连续观察、追踪随访临床确诊的阴囊急症87例。其中阴囊外伤13例，急性睾丸扭转12例，急性附睾炎32例，急性睾丸炎7例，急性睾丸一附睾炎15例，急性睾丸附件扭转8例。用高频二维超声观察左、右睾丸、附睾的形态大小及内部回声等；用彩色血流图及能量图观察血供信息。结果 以睾丸一附睾内无血供诊断睾丸扭转，敏感性、特异性和准确性均为100％。以睾丸或／和附睾肿大及高血供诊断急性睾丸或／和附睾炎，敏感性94．4％、特异性97％和准确性95．4％。结论 高频超声、彩色血流图及能量图在阴囊急症诊断中有重要的临床价值，尤其是在鉴别急性睾丸扭转、急性睾丸附件扭转和急性睾丸或／和附睾炎方面有快速、准确的意义。     

彩色多普勒血流显像在阴囊内疾病诊断中的价值

应用彩色多普勒血流显像（ＣＤＦＩ）观察了８０例阴囊内病变，并与手术病理结果及临床其他检查结果对照，诊断符合率为９２．５％。本文结果表明，ＣＤＦＩ可区别急性睾丸附睾炎或是睾丸扭转，能发现亚临床型精索静脉曲张，有助于阴囊内肿块性质的鉴别。     

彩色多普勒血流图评价急性阴囊肿痛

急性阴囊肿痛的常见病因有睾丸扭转、睾丸附睾炎及睾丸外伤,临床上即使有经验的泌尿科医生有时也很难准确诊断。以往主张早期手术探查,使约８０％的病人因患炎症而接受不必要的手术治疗。彩色多普勒血流图（ＣＤＦＩ）集二维超声和核素扫描的优点为一体,能同时显示睾丸附睾的形态学改变和血流动力学改变,因此,ＣＤＦＩ有助于诊断伴有血流循环异常的阴囊疾病。本文分析应用ＣＤＦＩ检查各种急性阴囊肿痛４１例,探讨ＣＤＦＩ的临床应用价值。１　资料和方法从１９９８年１２月至１９９９年６月,共检查急性阴囊肿痛４１例,患者平均年龄…     

阴囊急症的彩色多普勒和能量多普勒超声检查

阴囊急症是泌尿外科的一种常见急症 ,尤其在小儿外科更为常见 ,往往需要急诊手术探查。随着超声尤其是彩色多普勒血流显像 (ｃｏｌｏｒＤｏｐｐｌｅｒｆｌｏｗｉｍａｇ ｉｎｇ ;ＣＤＦＩ)和能量多普勒超声 (ｐｏｗｅｒＤｏｐｐｌｅｒｕｌｔｒａｓｏｕｎｄ ;ＰＤＵＳ)在阴囊疾病中的应用 ,绝大多数患者可在术前明确诊断 ,而避免不必要的手术创伤。现将这方面的研究现状综述如下 :1　阴囊急症的范围凡引起急性阴囊疼痛的病变统称为阴囊急症。包括阴囊外伤 ,睾丸扭转 ,睾丸附件扭转 ,阴囊扭转 ,精索扭转 ,附睾炎 ,附睾 睾丸炎 ,睾丸炎 ,急性特…     

彩色多普勒超声对非外伤性阴囊急症诊断价值的探讨

目的：评价彩色多普勒超声(CDFI)对非外伤性阴囊急症诊断的临床应用价值。方法：应用CDFI对45例非外伤性阴囊急症进行检查．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：CDFI诊断符合率为100％。其中睾丸扭转100％(17／17)，炎症100％(28／28)。17例睾丸扭转均表现睾丸内无血流灌注和低血流灌注．28例睾丸炎和附睾炎表现为睾丸和附睾内高血流灌注。结论：CDFI可成为早期鉴别诊断非外伤性阴囊急症的首选方法。     

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     

超声显像在小儿阴囊急症诊断中的价值

目的探讨高频彩色多普勒超声（CDFI）对小儿阴囊急症的诊断及鉴别诊断价值。方法应用高频二维及CDFI观察102例阴囊急症患儿病变的形态、结构、内部回声及血供情况,并与临床、手术及病理结果进行对照分析。结果睾丸附件扭转28例,睾丸扭转14例,急性鞘膜炎8例,急性睾丸炎11例,急性附睾炎19例,阴囊外伤12例,急性阴囊感染10例;超声诊断与临床及病理符合率为96．0％。结论高频CDFI对小儿阴囊急症诊断及时、准确、无创。     

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。     

彩色多普勒血流显像有阴囊内疾病诊断中的价值

应用彩色多普勒血流显像观察了８０例阴囊内病变，并与手术病理结果及临床其他检查结果对照，诊断符合率为９２．５％。本文结果表明，ＣＤＦＩ可区别急性睾丸附睾炎是睾丸所转，能发现亚临床型精索静脉曲张，有助于阴囊内仲块性质的鉴别。     

Color Doppler sonography in acute epididymitis and orchitis

Clinical diagnosis of patients with acute scrotal pain is frequently imperfect. Imaging, using nuclear medicine scintigraphy and hand-held continuous-wave Doppler ultrasound devices, has been used in these patients. We retrospectively analyzed 28 consecutive patients referred for scrotal sonography, all of whom had been imaged using color Doppler sonography. Of 22 patients with confirmed diagnoses, 11 had acute epididymitis/orchitis and 11 had another diagnosis. Ten of 11 patients with acute epididymitis/orchitis had increased epididymal flow. Eight also had increased testicular flow. None of the 11 patients without acute epididymitis/orchitis had increased flow. Our data suggest that color Doppler sonography may be useful in establishing the diagnosis of acute epididymitis/orchitis. This might decrease the need for scrotal exploration. No distinction could be made among scrotal lesions in the nonacute epididymitis/orchitis group. Sensitivity was inadequate to reliably detect flow in normal testicles, a prerequisite to accurately diagnose torsion. Newly improved sensitivity may enhance the utility of color Doppler sonography in assessing patients with acute scrotal pathology.     

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。     

The Clinical Utility of Serologic Markers in the Evaluation of the Acute Scrotum

OBJECTIVE: To examine the presence of interleukin-1 (IL-1), interleukin-6 (IL-6), and creatine phosphokinase-MM (CPK-MM) in patients with acute scrotal pain and assess their clinical utility in the diagnosis of testicular torsion (TT) and epididymitis. METHODS: Twenty-five patients with acute scrotal pain were prospectively enrolled over a two-year period. History, physical examination, complete blood count, urinalysis, and scrotal ultrasound were performed. Testicular torsion was confirmed by surgical exploration. Epididymitis was diagnosed using physical examination, scrotal ultrasound, and positive urinalysis. Venous blood was assayed for IL-1, IL-6, and CPK-MM in triplicate during the routine drawing of blood in the emergency department. The data are reported as medians +/- interquartile ranges (IQRs). RESULTS: Twenty-five patients with acute scrotal pain were evaluated; 11 with TT, three with torsion of the appendix testis (TAT), ten with epididymitis, and one with varicocele. One patient had both TT and epididymitis. Interleukin-1 was not detectable in either group. The CPK-MM values between TT and epididymitis were virtually identical at 99.8 and 100 IU/L, respectively. The median value for IL-6 was 1. 03 (IQR = 0.19 to 2.86) vs 20.86 (IQR = 2.14 to 65.50) pg/mL in the torsion and epididymitis groups, respectively. The 97.5% CI for the difference of medians of 19.9 was 0.4 to 65.1, p = 0.02. Using receiver operating characteristic (ROC) curve analysis for IL-6, the area under the curve was 0.82 for torsion and 0.67 for epididymitis. Using a cutoff value of IL-6 >/= 1.41 pg/mL, the positive predictive value of IL-6 in diagnosing epididymitis was 78.6%, with a negative predictive value of 100% for TT. There were no cases of missed TT on follow-up. CONCLUSIONS: This preliminary investigation of serologic markers demonstrates that IL-6 is significantly elevated in epididymitis as compared with TT. Creatine phosphokinase-MM and IL-1 were not found to be of diagnostic utility. The small sample size of this study precludes a definitive conclusion as to the utility of these markers in the emergency department. However, IL-6 may be clinically useful as an additional element in differentiating the causes of acute scrotal pain, and further study is warranted.     

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。     

高频彩色多普勒超声对近段输精管道梗阻部位与病因的研究

目的 探讨近段输精管道梗阻的高频彩色多普勒超声诊断价值。方法 使用5～10 MHz探头，对123例患者阴囊内容物进行检查，其中不育症88例，输精管结扎术后8例，附睾结节27例。对照正常输精管道声像图表现及手术、病理结果，分析输精管道梗阻的超声改变及梗阻的部位与原因。结果 123例患者中，输精管道梗阻有72例。其中输精管缺如6例，附睾畸形9例，附睾炎症37例，附睾肿瘤5例，睾丸网、输出小管扩张3例。22例手术所见及病理结果证实了超声诊断。结论 高频彩色多普勒超声能清晰显示梗阻后扩张的近段输精管道，并能判断梗阻的病因与部位，可为临床诊断与治疗方案的选择提供极有价值的信息。     

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.     

Emergency Evaluation of Patients Presenting with Acute Scrotum Using Bedside Ultrasonography

Acute scrotal pain is not a rare emergency department (ED) complaint. Traditional reliance on medical history and physical examination can be precarious as signs and symptoms can overlap in various etiologies of acute scrotal pain. OBJECTIVE: To determine the accuracy with which emergency physicians (EPs) using bedside ultrasonography are able to evaluate patients presenting to the ED with acute scrotal pain. METHODS: The study was performed at an urban community hospital ED with a residency program and an annual census of 70,000. A retrospective chart review identified 36 patients who presented with complaints of acute scrotal pain and were evaluated by EPs using bedside ultrasound. A 5.0- or 7.5-MHz linear-array transducer with color and power Doppler capability was used to scan the scrotum. Patients were seen between July 1998 and September 1999. Diagnoses were verified by radiology or surgery. Sensitivity and specificity with 95% confidence intervals were calculated. RESULTS: The EP ultrasound examinations agreed with confirmatory studies for 35 of 36 patients, resulting in a sensitivity of 95% (95% CI = 0.78 to 0.99) and a specificity of 94% (95% CI = 0.72 to 0.99). Diagnoses included three testicular torsions, six cases of epididymitis, four cases of orchitis, one testicular fracture, three hernias, three hydroceles, and 15 normal examinations. One case of epididymitis was misdiagnosed as an epididymal mass. CONCLUSIONS: This study suggests that EPs using bedside ultrasonography are able to accurately diagnose patients presenting with acute scrotal pain. In addition, they appear able to differentiate between surgical emergencies, such as testicular torsion, and other etiologies.     

Asymmetric spermatic cord vessel enhancement on CT: a sign of epididymitis or testicular neoplasm

Purpose

To determine whether asymmetric spermatic cord vessel enhancement (ASE) on contrast-enhanced computed tomography (CECT) indicates scrotal pathology.

Methods

Sixty-one male patients with scrotal symptoms who underwent both scrotal ultrasound (US) and CECT within 24 h were identified through a radiology information system. Twenty-eight emergency department patients who underwent CECT only for unrelated symptoms were included for comparison. Two blinded radiologists independently reviewed each CECT scan for qualitative ASE. These data were compared with US diagnoses, when present. A third blinded radiologist reviewed each CECT scan for quantitative ASE by measuring Hounsfield unit (HU) density ratios. McNemar, Kappa, Student’s t test, and ANOVA were used for analysis.

Results

Eighty-nine total patients included 28 with CECT only and 61 with CECT and US, of which 41 had abnormal US: 15 acute epididymitis and/or orchitis, 7 testicular neoplasms, 11 varicoceles, and 8 with other pathologies. Twenty patients with normal US and 28 patients with CECT only served as control groups. Identification of ASE agreed with US diagnosis of epididymitis (and/or orchitis) or testicular neoplasm (reader 1: κ = 0.79, reader 2: κ = 0.75) with average 95.5% sensitivity and 88.8% specificity, and no significant difference between readers (p = 0.58). For epididymitis (and/or orchitis) or testicular neoplasm patients, the average ratio of spermatic cord HU density (ipsilateral:contralateral) was significantly different from other patients (4.01 vs. 1.26, p = 0.0025).

Conclusion

ASE on CECT shows stronger correlation with epididymitis (and/or orchitis) and testicular neoplasm compared with other scrotal pathologies. If discovered on CECT, this should prompt further clinical and/or imaging workup.     

Scrotal swelling caused by acute necrotizing pancreatitis: CT diagnosis

Scrotal involvement is a rare complication of acute pancreatitis. It presents as scrotal swelling and skin color change, which mimics the presentations of testicular torsion, epididymitis, and testicular tumor. Its differential diagnosis is important because scrotal involvement of acute pancreatitis can be treated conservatively. Abdominopelvic CT provides a useful means of diagnosing this complication. Here, the authors present a case of acute pancreatitis extending to the left scrotum, mimicking a testicular tumor. A CT scan helped avoid unnecessary orchiectomy.