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。     

The Fountain Sign

Objective. Acute idiopathic scrotal edema (AISE) is an important differential diagnosis in children presenting with an acute scrotum. Sonography plays an important role in excluding testicular torsion, epididymitis, and torsion of a testicular appendage and confirming the diagnosis of AISE. The purpose of this series was to evaluate the relevance of color Doppler sonography (CDS) in children presenting with AISE. Methods. Ten patients with AISE who underwent CDS during a 25‐month period were retrospectively analyzed with regard to typical sonographic findings distinguishing AISE from other causes of scrotal edema. Results. Marked bilateral scrotal wall thickening and hyperemia resembling a fountain were detected in the transverse plane on CDS in all patients. Conclusions. This report highlights the usefulness of CDS in diagnosing AISE by showing that the “fountain sign” is related to hypervascularity of the scrotal wall. In an acute scrotum, this sign may help differentiate AISE from other etiologies.     

小儿阴囊急症的临床特征和高频超声表现

目的 探讨小儿阴囊急症的临床特征和高频超声表现.方法 分析112例小儿阴囊急症的超声和临床表现,并与最终诊断及治疗方案对照.结果 急性附件扭转65例,超声表现为睾丸上极或附睾头旁回声不均结节,伴或不伴继发反应性炎症.睾丸完全扭转21例,超声示患侧精索螺旋状扭曲成团,睾丸内无明显血流信号;不全扭转4例,患侧精索走行纡曲,睾丸内均可测及少量低阻血流信号.急性睾丸、附睾炎22例,除1例化脓性睾丸炎外,其余病例受累结构血供增多;超声诊断符合率约为98.21%(110/112).三者临床表现虽部分重叠但仍各具特征.15例附件扭转、25睾丸扭转及1例急性睾丸炎接受手术治疗,余均予以保守治疗.结论 客观、准确的急诊超声诊断报告,辅以全面深入的临床资料分析,可为小儿阴囊急症的诊疗提供重要帮助.     

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.     

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。     

Sonographic whirlpool sign in ovarian torsion.

OBJECTIVE: To describe an additional maneuver during sonography for ovarian torsion and to assess its diagnostic value. METHODS: During a period of about 2 years 6 months, 21 patients with acute or intermittent lower abdominal pain who had an ovarian mass and an extraovarian mass suggestive of a twisted vascular pedicle on sonography were studied. The gray scale features of the ovarian mass were recorded. The presence of a twisted vascular pedicle was evaluated. Its location and gray scale features were noted. The probe was moved to and fro along the axis of the pedicle, and the presence of a whirlpool sign was evaluated. The same procedure was repeated on a color Doppler study. RESULTS: A twisted pedicle with a whirlpool sign was seen in all 21 patients. Ovarian torsion was confirmed in all 20 patients who underwent surgery. The last patient was pregnant and did well with conservative treatment. Hemorrhagic infarction or early hemorrhage of the ovary or ovarian mass was seen in all 8 patients who did not show flow in the twisted pedicle on the color Doppler study and in 2 patients who showed flow in the artery in the proximal part of the pedicle. Of the 6 patients who showed flow in the artery alone, the ovary was removed in 4, and all had hemorrhagic infarction or early hemorrhage. The ovary was viable in all 5 patients in whom flow was seen in both the artery and vein. CONCLUSIONS: A positive whirlpool sign in the twisted vascular pedicle of the ovary is the most definitive sign of ovarian torsion. Absence of blood flow in the twisted pedicle and visualization of the flow in the artery alone are predictive of nonviability of the ovary.     

Role of Spectral Doppler Sonography in the Evaluation of Partial Testicular Torsion

Objective. The purpose of this series was to evaluate the role of spectral Doppler and color flow Doppler sonography in the evaluation of partial testicular torsion. Methods. Eight cases of partial testicular torsion, diagnosed on the basis of abnormal spectral Doppler waveforms or abnormal color flow Doppler findings, were retrospectively pooled from 2 teaching hospitals. Results. The age group ranged from 4 to 85 years. Testicles with partial testicular torsion showed variable spectral Doppler patterns, including increased, similar, or decreased amplitude of the arterial waveform relative to the contralateral testicle. Two cases showed reversal of arterial diastolic flow, and 1 case showed diastolic flow variability within the same testicle. Decreased blood flow was observed on color flow Doppler sonography in 7 of the 8 patients. Conclusions. Variability of the Doppler waveform when compared with the contralateral testicle and reversal of diastolic blood flow are indirect clues that aid in the diagnosis of partial testicular torsion.     

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.     

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。     

Isolated Torsion of the Fallopian Tube

Objective. The purpose of this series is to describe the sonographic features of isolated torsion of the fallopian tube. Methods. Sonography was performed in 4 women with acute lower abdominal pain. Results. The uterus and ovaries were normal in the 4 women. The ipsilateral fallopian tube was distended with fluid. A round mass was seen close to the tube. A sonographic whirlpool sign was seen on rocking movement of the probe over the mass. Ipsilateral torsion of the fallopian tube was confirmed at surgery in all of them. Conclusion . The sonographic whirlpool sign is the specific sign of tubal torsion.     

睾丸附件扭转的彩色多普勒超声诊断价值

目的：探讨彩色多普勒超声对睾丸附件扭转的诊断价值。方法对58例急性阴囊肿瘤的患儿进行灰阶及彩色多普勒超声检查，诊断睾丸附件扭转48例（49侧）；并对手术和保守治疗证实的48例患者的声像图进行回顾分析。结果：49例睾丸附件扭转中，超声显示睾丸附睾头间，睾丸上极和附睾头旁结节（扭转的睾丸附件）45例，结节多呈不均质高回声；42例结节内未显示血流信号，睾丸，附睾肿大及其血流信号增多41例；阴囊壁增厚39例，睾丸鞘膜积液31例，48例中，超声诊断正确45例，误诊3例，诊断符合为93．5％，结论：睾丸附睾头间及睾丸附睾旁高回声结节是睾丸附件扭转的特征性声像表现，彩色多普勒超声对本病诊断准确性高，可作为诊断睾丸附件扭转的最佳检查方法。     

Role of Doppler Ultrasonography in the Triage of Acute Scrotum in the Emergency Department

Objective. The purpose of this study was to examine the triage role of scrotal Doppler ultrasonography (DUS) as the primary preoperative diagnostic tool in patients presenting to the emergency department (ED) with acute scrotum. Methods. Patients who presented to the ED with acute scrotum and underwent scrotal DUS in the ultrasound unit over a 3‐year period (2004–2007) were included in the study. Patient characteristics, DUS findings, and clinical management were retrospectively collected and reviewed. Doppler ultrasonographic diagnoses were compared with histopathologic findings for patients who underwent exploration and with final diagnoses at the time of discharge for patients undergoing medical treatment. Results. A total of 620 consecutive patients with 669 DUS examinations were included. The most common scrotal DUS diagnoses were epididymitis, hydrocele, varicocele, and orchitis. Scrotal trauma was present in 77 cases. Hospitalization followed the initial ED evaluation for 155 patients; 68 underwent surgery. Testicular torsion was ultrasonographically suspected in 20 patients and confirmed in 18. Scrotal malignancy was incidentally diagnosed in 13 patients and testicular hematoma in 8. Doppler ultrasonography for the diagnosis of testicular torsion had 94% sensitivity, 96% specificity, 95.5% accuracy, an 89.4% positive predictive value (PPV), and a 98% negative predictive value (NPV). Doppler ultrasonography for the diagnosis of testicular malignancy had 92% sensitivity, 95% specificity, 94% accuracy, a 78.5% PPV, and a 98% NPV. Conclusions. Scrotal DUS is a highly sensitive preoperative diagnostic tool, thereby validating its routine use in the initial triage of patients with acute scrotum presenting to the ED.     

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.     

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.     

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。     

超声在睾丸疾病诊断中的应用

目的探讨超声检查在睾丸疾病诊断中的应用价值。方法本文对49例经二维和彩色多普勒超声诊断（以下简称CDFI）@睾丸疾病的声像图特征及彩色多普勒血流特点进行总结，并结合手术及病理结果进行综合分析。结果49例睾丸疾病中睾丸肿瘤31例，占63．27％。其它为睾丸炎6例，占12．24％；睾丸扭转4例，占8．16％；睾丸外伤6例，占12．24％；睾丸微石症2例，占4．1％。结论超声对睾丸肿瘤的良恶性诊断具有很高的敏感性和准确性，对睾丸扭转、睾丸炎、睾丸外伤等疾病的诊断和鉴别诊断有重要作用，是诊断睾丸疾病最理想的检查方法。     

实验性睾丸不全扭转的彩色多普勒超声研究

目的探讨实验性睾丸扭转的早期彩色多普勒超声特征。方法选用6只健康杂种犬,制成12个睾丸不全扭转模型。应用7～14MHz探头,连续24h观察扭转前、后不同时段睾丸及精索彩色多普勒超声表现,并与相应时段睾丸穿刺活检病理结果对比研究。结果扭转后睾丸体积较扭转前显著增大(P<0.05),睾丸在血流信号消失后开始出现不均匀回声,扭转上段的睾丸动脉阻力指数较扭转前显著增高(P<0.05),扭转下段睾丸动脉、睾丸包膜动脉及睾丸内动脉血流阻力指数较扭转前显著降低(P<0.05)。病理结果显示睾丸在不同时段发生不同程度的损害。结论睾丸不全扭转24h内的动态超声表现揭示了睾丸扭转早期血流动力学变化的病理基础,为临床早期诊断睾丸扭转提供较可靠的实验依据。     

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.     

Variation in the evaluation of testicular conditions across United States pediatric emergency departments

Objectives

To explore the variation in diagnostic testing and management for males diagnosed with three testicular conditions (testicular torsion, appendix testis torsion, epididymitis/orchitis) using a large pediatric health care database. Diagnostic testing is frequently used in evaluation of the acute scrotum; however, there is likely variability in the use of these tests in the emergency department setting.

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.