超声检查在儿童睾丸附件扭转和急性附睾炎鉴别诊断中的应用

目的 探讨超声检查在儿童睾丸附件扭转和急性附睾炎诊断及鉴别诊断中的应用价值.方法 回顾性分析39例睾丸附件扭转和14例急性附睾炎二维及彩色多普勒超声声像图特点,总结两者鉴别要点.结果 睾丸附件扭转超声表现为睾丸与附睾头之间或睾丸旁高回声或中等回声结节,常伴附睾增大、阴囊壁增厚、鞘膜积液,附睾或睾丸内血流轻度增多.急性附睾炎超声表现为附睾增大,回声减低或增高,常伴阴囊壁增厚、鞘膜积液.附睾内血供丰富,并发睾丸炎时,睾丸增大,回声减低,但是睾丸与附睾头之间或睾丸旁未探及高回声或中等回声结节.结论 超声检查在儿童睾丸附件扭转和急性附睾炎诊断及鉴别诊断中具有一定价值,其中睾丸与附睾头之间或睾丸旁出现高回声或中等回声结节是两种疾病的鉴别要点.     

小儿阴囊急症的鉴别诊断和手术治疗

目的探讨小儿阴囊急症的鉴别诊断及治疗方法。方法总结分析我院近7年收治的小儿阴囊急症病例资料。结果133例阴囊急症中睾丸附件扭转105例(79.0%),睾丸附睾炎16例(12.0%),睾丸扭转4例(3.0%),其他8例(6.0%)。附件扭转以6～12岁居多,其阴囊肿痛程度较睾丸附睾炎为轻(P<0.005)。在睾丸附件扭转中蓝斑征9例(8.6%),痛性结节23例(21.9%),超声附件检出率为90.5%。手术中发现不完全性坏死附件、哑铃状附件节间扭转、慢性附件扭转等特殊病例。睾丸附睾炎好发于6岁内,可双侧发病或反复发作。睾丸扭转其提睾反射均消失,超声显示睾丸无血流。结论小儿阴囊急症以睾丸附件扭转最常见,睾丸扭转发病最急。病史、体征及超声检查有助于鉴别诊断,主张积极探查手术。     

儿童睾丸附件扭转的保守治疗指征

目的探讨儿童睾丸附件扭转保守治疗的指征。方法回顾性总结分析1993～1997年底的25例急性阴囊疼痛患儿的诊疗情况,结合文献提出鉴别诊断及选择疗法的依据,将其应用于1998年以后收治的26例患儿中,进一步探讨诊断和治疗指征。结果回顾性总结表明睾丸扭转症状重,就诊早,就诊时间多在发病24h之内。附件扭转疼痛轻,就诊晚,多有48h以上的病史,两者比较,差异有显著性意义(P＜0.05)。1998年后治疗的26例中,5例就诊时疼痛时间短于48h,1例在睾丸上极摸到疼痛性结节,诊断睾丸附件扭转,行保守治疗;4例行急症手术,证实1例睾丸扭转、3例附件扭转。21例就诊时疼痛已48h以上,19例症状轻,彩色多普勒检查,睾丸血流正常,行保守治疗,治疗过程中均可摸到大小不等的触痛性结节,诊断睾丸附件扭转。2例睾丸扭转坏死而行睾丸切除。结论睾丸附件扭转是一种自限性疾病。扪到其特有体征,即阴囊内触疼性结节者;阴囊痛持续48h以上,彩色多普勒检查,睾丸血流正常者,可行保守治疗。睾丸扭转是外科急症,应急症手术。彩色多普勒超声检查对鉴别诊断有重要意义。     

睾丸附件扭转33例

目的 分析小儿睾丸附件扭转的临床特点和治疗方法.方法 回顾性分析本院1999年8月-2007年8月收治的33例小儿(3.2～14.0岁)睾丸附件扭转临床治疗.20例于治疗前行彩色多普勒超声(CDFI)检查,记录检查结果.33例分为手术组23例和保守治疗组10例,记录手术组术中所见睾丸附件情况及切除福建的病理检查结果,比较二组患儿平均住院时间、平均阴囊红肿消退时间.结果 睾丸附件扭转以阴囊肿痛为主要表现,CDFI检查表现为睾丸上极附近无血流回声团.手术组和保守治疗组均取得满意疗效.手术组阴囊红肿消除时间为(5.0±1.0)d,保守组为(9.1±5.2)d;住院时间分别为(5.2±2.3)d和(8.9±6.6)d,二组比较,均有显著性差异(t=2.26, 3.12 P<0.05).对病程长、症状轻的病例,在阴囊红肿消退时间和住院时间等方面手术组均优于保守组,术后B超显示睾丸附件可恢复正常.结论 CDFI检查哈在小儿睾丸附件扭转的诊断中具有重要意义,早期手术治疗睾丸附件扭转有利于睾丸及附睾炎性反应得吸收.     

小儿膀胱横纹肌肉瘤与膀胱炎性增生性结节的彩色多普勒超声比较

目的探讨彩色多普勒超声在小儿膀胱横纹肌肉瘤与膀胱炎性增生性结节的诊断与鉴别诊断中的价值。方法应用彩色多普勒超声对30例膀胱增生性病变进行诊断,全部病例均经手术或病理检查证实。二维超声观察增生性病变的位置、大小、外形、表面、内部回声、与膀胱肌层的关系等,彩色多普勒超声观察增生性病变的血流分布情况,并进行对照分析：结果本组30例中,11例为膀胱横纹肌肉瘤．11例为炎性增生性结节,8例为不均匀性膀胱壁增厚;其中1例增生性结节误诊为横纹肌肉瘤。膀胱横纹肌肉瘤与炎性增生性结节的彩色多普勒超声均有各自的特点。结论彩色多普勒超声在膀胱横纹肌肉瘤与膀胱炎性增生性结节的诊断与鉴别诊断中具有重要的临床意义。     

364例阴囊急症的诊疗分析

目的探讨小儿阴囊急症的鉴别诊断和治疗方法。方法回顾性分析作者于2006年3月至2010年12月收治的364例阴囊急症患儿临床资料。结果364例阴囊急症患儿中,急性附睾炎221例（占61%）,年龄3个月至5岁多见,症状出现较早,并以起病2~3 d最剧烈,实验室检查异常26例（11%）。彩色多普勒超声提示附睾增大、充血和睾丸反应性改变,检出率99%。3例超声检查诊断困难,后经手术证实。112例睾丸附件扭转中,痛性结节93例（83%）,蓝斑征26例（23%）,超声附件检出率100%。所有患儿初期症状较轻,逐渐加剧,保守治疗1~2周后疼痛逐渐减轻。11例睾丸扭转超声检查显示睾丸无血流予手术治疗。8例出现特发性阴囊水肿,12例出现阴囊感染。结论小儿阴囊急症中以急性附睾炎最常见,病史、体查和多普勒超声检查有助于阴囊急症的鉴别诊断。大多数小儿急性附睾炎可以保守治疗。     

彩色多普勒超声诊断小儿睾丸畸胎瘤1O例分析

目的分析小儿睾丸畸胎瘤彩色多普勒超声检查的影像学特点。方法对20例临床疑诊为睾丸肿瘤的患儿进行彩色多普勒超声检查,其中10例同时进行CT检查,并经手术病理检查证实。结果10例彩色多普勒超声检查均提示为睾丸畸胎瘤,其中4例为良性畸胎瘤,超声显示其边界清晰,包膜完整,彩色多普勒显示其内部及周边血流信号少;6例为恶性畸胎瘤,超声显示其边界不清,未见明显包膜,彩色多普勒显示其内部及周边血流信号较丰富。CT提示9例为睾丸畸胎瘤,1例未能明确诊断。结论彩色多普勒超声对小儿睾丸畸胎瘤的诊断较CT检查有更多的影像学特点及优势,是诊断小儿睾丸畸胎瘤的首选方法。     

小儿睾丸疾病外科急诊20例报告

小儿阴囊红肿、疼痛多见于睾丸扭转、附睾睾丸炎、睾丸附件扭转。提高对阴囊急诊的认识,以及彩色多普勒超声血流显像等辅助诊断技术的应用,对早期睾丸扭转的手术复位以挽救睾丸,和避免不必要的手术探查起了重要作用。     

睾丸扭转术中应用彩色多普勒评价睾丸活力的实验研究

目的 探讨在睾丸扭转术中应用彩色多普勒判断缺血睾丸活力的价值.方法 选取56只健康雄性新西兰大白兔,随机分7组,每组8只:①组不作任何手术处理;②组将左侧精索手术游离暴露10min③、④、⑤,⑥和⑦组分别用动脉夹将左侧精索完全夹闭,计时0.5、1.5、3、6、12 h.彩超检查时,将动脉夹移除.彩超分别观察并计算左右睾丸体积、彩色血流显示面积百分比r(r=血流显示面积a/睾丸最大纵切面面积A),左右睾丸r值之比尺(R=r左/r右).取各组左侧睾丸组织常规制作HE染色光镜及透视电镜标本并观察.结果 ①组与②组左右侧睾丸体积大小组内比较均无显著差异(P>0.05),各缺血组左侧睾丸体积较右侧明显增大,差异有显著统计学意义(P<0.05);①、②、③和④组睾丸呈均匀细小等回声,⑤、⑥和⑦组睾丸回声小均匀,局部出现低回声.①组与②组左右睾丸R值比较差异均无统计学意义.③、④、⑤、⑥和⑦组与①和②组R值两两比较差异均有显著统计学意义;①、②、③和④组光镜睾丸生精小管上皮及间质细胞结构变化轻微甚至无改变;⑤、⑥和⑦组光镜小管内皮细胞脱落,间质充血、出血,电镜观察细胞核染色质呈颗粒状聚集,染色质边集,细胞器溶解,细胞核固缩,碎裂,细胞器溶解消失.结论 彩色多普勒对于缺血睾丸再灌注后血流检测敏感,可用于睾丸扭转术中判断睾丸血供、预测睾丸活力,对于外科手术决定保留或切除扭转睾丸具有重要指导意义和实用价值.     

彩色多普勒超声诊断小儿急性阑尾炎的临床应用研究

目的探讨彩色多普勒超声诊断小儿急性阑尾炎的临床应用。方法对临床拟诊的78例急性阑尾炎的患儿全部行彩色多普勒超声检查以明确诊断及鉴别诊断。结果78例临床拟诊的急性阑尾炎病人，经彩色多普勒超声检查诊断为急性阑尾炎的51例，全部行手术治疗，经手术及术后病理检查50例证实为急性阑尾炎。本组出现假阳性1例，假阴性1例，准确率为97．7％。结论采用无创伤性、简单安全的彩色多普勒超声诊断小儿急性阑尾炎可靠、准确，值得推广应用。     

Color Doppler sonography in the diagnosis of acute scrotum in boys.

Evaluation of acute painful scrotum is difficult and imaging studies have been reported to be unreliable in detecting testicular torsion. In order to assess the value of color Doppler sonography in acute scrotal disease, the authors reviewed 65 consecutive boys, ranging in age from 1 to 16 years. The study demonstrated absent or diminished flow signals in 11 patients. All of them had a surgical intervention, and in 8 of them, a testicular torsion was confirmed. 54 boys had a symmetrical or increased flow signal on the affected side. Just 5 boys among this group underwent surgical exploration. On follow up, none of the 54 patients with good flow signals proved to have a testicular torsion. Sonography and color Doppler sonography helped to differentiate epididymitis and torsion of a testicular appendage as a basis for further investigations and correct conservative therapy. In detecting a testicular torsion, color Doppler sonography yielded a positive predictive value of 73%, a sensitivity of 100% and a negative predictive value of 100%. We therefore conclude, that Doppler sonography can reliably rule out testicular torsion so that routine scrotal exploration in cases of acute scrotum is no longer necessary. By reducing the number of emergency operations and hospitalization days, color Doppler sonography can cut down the total cost of managing acute painful scrotum in boys.     

Early scrotal exploration in all cases is the investigation and intervention of choice in the acute paediatric scrotum

The acute scrotum in the paediatric population is a clinical dilemma where a definitive diagnosis can only truly be made at surgical exploration. We postulate that surgical exploration in all cases allows truly accurate diagnoses, treats the torted appendage testes and enables the validity of clinical signs associated with scrotal pathology to be assessed. We retrospectively reviewed all boys less than 15 years old who presented to our institution with scrotal pain over a 2 year period. A total of 121 patients attended of whom 113 had exploratory surgery, 31 (27%) had testicular torsion, 64 (57%) had a torted appendage testis, 12 (11%) had epididymitis, 1 (1%) had fat necrosis and 5 (4%) had no abnormality detected. On exploration 9 (29%) of the torted testis were unsalvageable and thus required excision. The initial clinical impression was frequently demonstrated to be flawed. Two patients with testicular torsion presented with a painless swelling and two further patients had necrotic testes despite a history of pain for less than 4 h. A normal cremasteric reflex and a visible blue dot were detected in boys with testicular torsion. Doppler ultrasound scans were not reliable with 50% sensitivity to clearly differentiate between torsion of the testis and that of the appendage testis. Absolute dependence on clinical features can lead to a misdiagnosis of testicular torsion. The surgical treatment of torted appendage testis is safe, allowing accurate diagnosis and pain relief with minimal morbidity. Early scrotal exploration of all cases with testicular pain ensures maximal testicular salvage.     

Clinical and sonographic criteria of acute scrotum in children: a retrospective study of 172 boys

Background: Diagnosis of testicular torsion in children is challenging, as clinical presentation and findings may overlap with other diagnoses. Objective: To define the clinical and ultrasound criteria that best predict testicular torsion. Materials and methods: The records of children hospitalized for acute scrotum from 1997 to 2002 were reviewed. The clinical and ultrasound findings of children who had a final diagnosis of testicular torsion were compared with those of children who had other diagnoses (torsion of the testicular appendix, epididymitis, and epididymo-orchitis). Results: Forty-one children had testicular torsion; 131 had other diagnoses. Stepwise regression analysis yielded three factors that were significantly associated with testicular torsion: duration of pain 6 h; absent or decreased cremasteric reflex; and diffuse testicular tenderness. When the children were scored by final diagnosis for the presence of these factors (0–3), none of the children with a score of 0 had testicular torsion, whereas 87% with a score of 3 did. The ultrasound finding of decreased or absent testicular flow had a sensitivity of 63% and a specificity of 99%. Eight of ten children with testicular torsion and normal or increased testicular flow had a coiled spermatic cord on ultrasound. Conclusion: We suggest that all children with acute scrotal pain and a clinical score of 3 should undergo testicular exploration, and children with a lower probability of testicular torsion (score 1 or 2) should first undergo diagnostic ultrasound. Because the presence of testicular flow does not exclude torsion, the spermatic cord should be meticulously evaluated in all children with acute scrotum and normal or increased testicular blood flow.     

Acute epididymitis in Greek children: a 3-year retrospective study

The aim of the study was to compare historical features, physical examination findings, and testicular color Doppler ultrasound in pediatric patients with epididymitis compared to testicular torsion and torsion of the appendix testes. A retrospective review of the medical records of 66 boys presenting with clinical aspects of acute scrotum over a 3-year period was performed. Sixty-six patients were included in the study (29 with epididymitis, 8 with testicular torsion and 12 with torsion of the appendix testis, 4 with scrotal abscesses, 5 with scrotal swelling, and 1 with inflamed epididymal cyst). The duration of symptoms ranged from 6 h to 4 days with a peak on the second day. Urine cultures and viral testes were negative in all patients. Color Doppler ultrasound was diagnostic for epididymitis in 28 patients (96.6%). Systemic intravenous antibiotics were given in all 29 patients with epididymitis. No patient showed signs of testicular atrophy in the follow-up. The increasing incidence of epididymitis should question the policy of routine exploration of the acute scrotum in children. The history and physical examination cannot reliably identify those boys who can be managed conservatively. Color Doppler ultrasound is a useful adjunct in the evaluation of the acute scrotum when physical findings are equivocal but it can also be misleading.     

The tender scrotum

Although scrotal pain and swelling are rarely life threatening, a patient who presents with a tender scrotum should be considered a surgical emergency until the etiology is uncovered. The loss of a testicle and even sterility may occur if the diagnosis of testicular torsion is delayed. In most cases, a careful history and thorough physical examination are all that are needed in making the diagnosis. In the equivocal case, a Doppler ultrasound is helpful in distinguishing surgical versus nonsurgical problems. This chapter will cover the most common causes of a tender and nontender scrotum; testicular torsion, epididymitis, torsion of appendage testis, trauma, incarcerated hernia, hydrocele, reducible hernia, nephrotic syndrome, Henoch-Schönlein purpura, and Kawasaki disease. This chapter will also discuss the appropriate workup and diagnostic tests for each of these entities and when immediate surgical consultation is necessary.     

Spiral twist of the spermatic cord: a reliable sign of testicular torsion

Background. Colour Doppler sonography (CDS) has become the procedure of choice in evaluating testicular perfusion but false negative findings have been reported. Objective. To determine if direct visualisation of the twisted spermatic cord using high resolution US is a reliable sign to assess testicular torsion. Material and methods. Thirty patients (aged 2–26 years) with equivocal diagnosis of testicular torsion prospectively underwent high resolution and CDS. The results were correlated with surgical findings. Serial transverse and longitudinal scans were performed to compare the scrotal contents on each side and study the complete spermatic cord course, from inguinal canal to testis, to detect a spiral twist. Results. In 14 of the 23 cases of torsion, the diagnosis was based on the colour Doppler findings in the scrotum because blood flow was absent in the symptomatic testis and detectable without difficulty on the normal side. In nine cases, CDS was unreliable; in six cases intratesticular perfusion was present in a twisted testis and in three small boys, no colour signal was obtained in either testis. In all cases of torsion, the spiral twist of spermatic cord was detected at the external inguinal ring. The twist induced an abrupt change in spermatic cord course, size and shape below the point of torsion. It appeared in the scrotum as a round or oval, homogeneous or heterogeneous extratesticular mass with or without blood flow, that could be connected cephalad with the normal inguinal cord. In the other seven cases (three late torsions of the appendix testis, one epididymo-orchitis and three torsions with spontaneous reduction), no spiral twist was detectable. Conclusion. The detection of spermatic cord spiral twist appears a reliable US sign of torsion whatever the testicular consequences. Received: 1 December 1997 Accepted: 17 June 1998     

Colour Doppler ultrasonography replacing surgical exploration for acute scrotum: myth or reality?

Background: Traditionally, every patient with an acute scrotum needed surgical exploration for definitive exclusion of testicular torsion. Objective: In this study, we aimed to evaluate the improved accuracy in clinical diagnosis with colour Doppler Ultrasonography (US) added to normal clinical assessment. Materials and methods: We retrospectively reviewed 626 patients, who presented with acute scrotal pain between January 1998 and June 2004. Following history and physical examination, the patients either proceeded directly to surgery or underwent US examination. If clinical suspicion of testicular torsion persisted after US, the patients would still undergo scrotal exploration. Results: Of the 294 patients who had routine scrotal exploration without preliminary US, only 23 (7.8%) were found to have testicular torsion. Amongst the 332 cases that had initial US, 9 (2.7%) patients revealed testicular torsion that was confirmed at subsequent surgery. The remaining 323 patients had initial negative US, but 29 were explored eventually on clinical indications. Of these, 4 (1.2% of 323) cases were diagnosed intra-operatively as testicular torsion. None of the remaining 294 patients who were managed conservatively proved to have testicular torsion after a minimum follow-up of 2 weeks. For testicular torsion, US yielded a sensitivity of 69.2% (95% confidence interval =38.9–89.5), specificity of 100% (95% CI=98.5–100), positive predictive value of 100% and negative predictive value of 97.5%. Conclusions: US has proven to decrease the number of emergency scrotal explorations, length of hospital stay and hence reduce the cost of management of acute scrotum.     

Age for testicular torsion?]

Classically, testicular torsion occurs in neonates or during puberty. Between these two ages, is it really an exception? METHOD AND PATIENTS: In order to answer the question, we reviewed the charts of the patients referred to the department of pediatric surgery of Bicêtre hospital between 1992 and 2001. We studied the preoperative examinations, the operative data and the long term evolution. Cases of torsion occurring during neonatal or pubertal periods were excluded. RESULTS: During nine years, 86 patients with "acute scrotum symptoms" underwent surgery. The ages of patients ranged from one month to 11 years (average age: five years) in 26 patients, among which 12 had true testicular torsion. Consultation at the emergency room occurred after one to 72 hours (average of 17). The localization of the pain was on the left in eight cases and on ectopic testicle in two. The testicular volume was increased in 11 cases. Cremasteric reflex was absent in four cases. The doppler flow was normal in four cases and absent in four. During surgery, the testis appearance was considered as normal in six testicles, as necrotized in three (and an orchidectomy was performed) and as ischemic in three. In seven cases, a peroperative contralateral testicle fixation was performed and later one in two. The postoperative course was simple, without infection and with a normal testicular volume in eight cases, increased in one ischemic testis. Testicular atrophy was noted in an ischemic testis, after several months. CONCLUSION: Whatever the age, testicular torsion remains a surgical emergency even with a normal doppler flow.