Sonographic findings in testicular sarcoidosis simulating malignant nodule

Testicular involvement by sarcoidosis is rare. We report a case of a patient with known sarcoid who had a unilateral testicular nodule with apparent capsular invasion on sonography. The epididymis was normal on both sides. Despite these atypical features, pathology showed the nodule to be a sarcoid granuloma. In patients with sarcoidosis, the differential diagnosis of an intratesticular mass should include testicular involvement by sarcoid. © 1999 John Wiley & Sons, Inc. J Clin Ultrasound 27:81–83, 1999.     

正常青春期睾丸内血流显像与睾丸体积和年龄的相关性研究

目的:探讨正常青春期睾丸血流灌注情况与睾丸体积和年龄的关系。方法:CDFI对141例正常青春期青少年的睾丸体积和睾丸内血流显像分别进行观测并分级。对睾丸内血流显像与睾丸体积和年龄的相关性分别统计分析。结果:正常青春期左、右两侧睾丸血流显像无显著性差异(P>0.05)。睾丸内血流信号显像级别与睾丸体积存在正相关:Scale=0.035m/s时r=0.198(P<0.01),Scale=0.047m/s时r=0.269(P<0.01)。睾丸内血流信号显像级别与年龄也存在正相关:Scale=0.035m/s时r=0.175(P<0.01),Scale=0.047m/s时r=0.219(P<0.01)。结论:正常青春期睾丸内血流信号的显像级别与睾丸体积和年龄均密切相关,睾丸体积的相关性大于年龄的相关性。当应用CDFI评价青春期睾丸内血流灌注情况时,睾丸体积是一个更为适合的参照指标。     

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。     

Global Testicular Infarction in the Presence of Epididymitis

Epididymitis is common, presenting indolently with unilateral scrotal pain and swelling. Diagnosis is based on clinical assessment and resolves with antibiotic therapy. Recognized complications are abscess formation and segmental infarction. Global testicular infarction is rare. Diagnosis is important and requires surgical management. On grayscale sonography, global infarction may be difficult to establish. The addition of color Doppler imaging is useful but is observer experience dependent with limitations in the presence of low flow. Contrast‐enhanced sonography is useful for unequivocally establishing the diagnosis. We report global testicular infarction in 2 patients with epididymitis clearly depicted on contrast‐enhanced sonography, allowing immediate surgical management.     

Segmental testicular infarction as a complication of varicocelectomy: sonographic findings

Segmental testicular infarction is a rare clinical entity with various causes. We report the gray-scale and color Doppler sonographic findings of a case of segmental testicular infarction associated with varicocelectomy.     

彩色多普勒超声诊断和鉴别诊断小儿睾丸扭转

目的 评估彩色多普勒超声诊断及鉴别诊断小儿睾丸扭转的价值。 方法 回顾分析因急性阴囊肿痛而接受彩色多普勒超声检查的125例患儿的声像图特征,并与手术病理、临床最终诊断相比较。 结果 125例中,急性睾丸扭转14例,超声诊断符合率92.86%(13/14),均接受手术治疗,其中11例睾丸完全坏死切除,CDFI显示睾丸内无明显血流信号,3例手术复位后睾丸存活,CDFI示睾丸内有少量血流信号;急性睾丸附件扭转68例,睾丸上极或与附睾间见回声不均质结节,内无血流信号,超声诊断符合率97.06%(66/68);急性附睾炎43例,附睾内血流信号明显增多,超声诊断符合率100%(43/43)。 结论 彩色多普勒超声对小儿睾丸扭转具有较高的诊断及鉴别诊断价值,是临床首选的影像检查方法。     

Ultrasound of the scrotum

Ultrasound plays an important role in the diagnostic workup of scrotal diseases. It can differentiate a testicular mass from an extratesticular mass and determine whether the mass is cystic, solid, or complex. Using this information a likely diagnosis can be ascertained. In the acute scrotum, acute epididymitis/epididymo-orchitis can in most cases be distinguished from testicular torsion. Following scrotal trauma, surgery is needed to salvage the testis if there is testicular disruption and ultrasound can help with this diagnostic dilemma. When a large hydrocele is present, ultrasound allows evaluation of the underlying testis and epididymis and it can detect varicoceles, especially in the infertile male. In patients at risk for a testicular tumor (cryptorchid testis, testicular microlithiasis), ultrasound is the best imaging modality for follow-up. CT, MRI, and nuclear medicine scanning may be necessary for further evaluation of scrotal diseases and this will be briefly addressed.     

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。     

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.     

彩色多普勒超声在睾丸扭转和睾丸附件扭转诊断及鉴别诊断中的应用

目的：探讨彩色多普勒超声在睾丸扭转和睾丸附件扭转诊断及鉴别诊断中的应用价值。方法：分析44例睾丸扭转和37例睾丸附件扭转彩色多普勒超声声像图特点, 总结二者鉴别诊断要点。结果：睾丸扭转特异性表现为睾丸内血运减少或消失以及睾丸上方无血运高回声团块。睾丸附件扭转超声表现为睾丸与附睾头之间或睾丸旁不均质高回声结节及睾丸、附睾内血运轻度增多。结论：彩色多普勒超声在睾丸扭转和睾丸附件扭转诊断及鉴别诊断中具有重要诊断价值。     

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。     

高频彩色多普勒超声对睾丸精原细胞瘤的诊断价值

目的 :总结睾丸精原细胞瘤的声像图特征 ,探讨超声在此类疾病中的诊断价值。方法 :分析总结了 3 9例经术后病理证实的睾丸精原细胞瘤的二维及彩色多普勒超声特征。结果 :睾丸精原细胞瘤声像图表现为 :外生肿块型 9例、内生肿块型 2 6例、弥漫浸润型 4例。 3 9例睾丸精原细胞瘤 ,伴腹股沟及腹膜后淋巴结转移 14例。结论 :高频超声对睾丸精原细胞瘤的诊断及鉴别诊断有很大价值 ,可为临床诊断及治疗提供可靠的信息     

ACR Appropriateness Criteria ® acute onset of scrotal pain--without trauma, without antecedent mass

Men or boys, who present with acute scrotal pain without prior trauma or a known mass, most commonly suffer from torsion of the spermatic cord; epididymitis or epididymoorchitis; or torsion of the testicular appendages. Less common causes of pain include a strangulated hernia, segmental testicular infarction, or a previously undiagnosed testicular tumor. Ultrasound is the study of choice to distinguish these disorders; it has supplanted Tc-99 m scrotal scintigraphy for the diagnosis of spermatic cord torsion. MRI should be used in a problem solving role if the ultrasound examination is inconclusive. The ACR Appropriateness Criteria ? are evidence-based guidelines for specific clinical conditions that are reviewed every two years by a multidisciplinary expert panel. The guideline development and review include an extensive analysis of current medical literature from peer reviewed journals and the application of a well-established consensus methodology (modified Delphi) to rate the appropriateness of imaging and treatment procedures by the panel. In those instances where evidence is lacking or not definitive, expert opinion may be used to recommend imaging or treatment.     

Intratesticular varicocele

Varicocele is a common condition, occurring in approximately 15% of males. We present a case of intratesticular varicocele with concomitant extratesticular varicocele. A routine sonographic examination of the left testis revealed multiple hypoechoic, serpiginous, tubular intratesticular structures of various sizes with low-level internal echoes. Duplex Doppler and color flow examination confirmed a low-flow venous pattern with phasic variation that increased during Valsalva's maneuver. These findings were consistent with intratesticular varicocele. Varicocele was also present in the left pampiniform plexus. The main differential considerations in a patient with intratesticular varicocele include cyst, hematoma, epidermoid cyst, and tubular ectasia. © 1998 John Wiley & Sons, Inc. J Clin Ultrasound 26 : 49–51, 1998.     

Sonographic features of focal orchitis

High-resolution sonography is a very sensitive imaging modality for detecting intratesticular pathology and is an accurate means of distinguishing intratesticular lesions (usually malignant) from extratesticular ones (usually benign). Unfortunately, there are no reliable sonographic criteria to distinguish testicular neoplasms from focal benign intratesticular lesions such as infarction, hemorrhage, or infection. We describe three cases of focal orchitis in which the sonographic features did allow a confident diagnosis of intratesticular infection. In each case a focal peripheral hypoechoic intratesticular abnormality was seen that was poorly defined or crescent-shaped, adjacent to an enlarged epididymis. The specific sonographic features suggest the diagnosis of focal orchitis and orchiectomy can be prevented. Rapid improvement (2 to 4 weeks) should be seen sonographically and in all cases the intratesticular lesions should be followed to complete resolution.     

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.     

Imaging of the epididymis

Ultrasonography performed with a high-frequency transducer is the modality of choice for evaluating acute and nonacute scrotal disease. Acute epididymitis and epididymo-orchitis are the most common conditions that present with acute scrotal pain. Differentiation of these from testicular torsion is important for determining the appropriate management. High-transducer sonography allows the visualization of the epididymis and its detailed anatomy. We present important sonographic features of epididymitis and epididymo-orchitis caused by infectious and noninfectious etiologies. Features of benign and malignant epididymal lesions, including epididymal cysts, spermatoceles and tubular ectasia, sperm granulomas, adenomatoid tumors, leiomyomas, papillary cyst adenomas, lymphoma, and metastases are also presented. In addition, epididymal trauma and torsion are discussed. The goal of the review is to provide the radiologist with a better understanding of the numerous pathological conditions that occur in the epididymis.     

附睾炎的超声诊断

目的总结附睾炎高频彩色多普勒超声图像特征及超声对附睾炎的诊断价值。方法对55例经高频彩色多普勒超声检查并经手术、病理确诊的附睾炎患者的声像图资料进行回顾性分析。结果55例附睾炎中,慢性附睾炎36例、附睾精子肉芽肿性炎9例、急性附睾炎7例及附睾结核3例。其中2例附睾精子肉芽肿性炎和1例急性附睾炎误诊为附睾肿瘤。结论高频彩色多普勒超声结合临床资料综合分析,能准确诊断附睾炎。     

Thrombotic and Nonthrombotic Types of Intratesticular Varicoceles: Value of Sonography for the Diagnosis

An intratesticular varicocele is an uncommon entity, and its clinical importance remains unclear. The diagnosis can be made in the case of an intratesticular tortuous vein that shows retrograde flow on color Doppler sonography. The anatomic location and course of the intratesticular varicocele within the testicular parenchyma and its association with the existence of an ipsilateral extratesticular varicocele may vary among patients. The pathophysiologic mechanisms remain unclear; however, it may be questioned whether there is an association between testicular atrophy and intratesticular varicocele development. Although the diagnosis is usually made incidentally, patients may rarely present with acute scrotal pain due to acute thrombosis of an intratesticular varicocele.     

彩色多普勒超声在附睾结核治疗中的应用价值

目的探讨附睾结核的彩色多普勒超声分型及其在治疗中的价值。方法对33例附睾结核患者的彩色多普勒超声表现及手术所见进行对比分析。结果对33例附睾结核患者超声正确诊断29例，诊断符合率为87．9％。3例附睾呈弥漫性病变，血供丰富；13例附睾内见结节病灶，其中3例结节内有液性无回声区，3例内有点状高回声区，7例呈低回声；17例阴囊内多发病灶，其中11例附睾表现为弥漫肿大、回声不均、血供增多。附睾结核依发生部位可将超声表现分为弥漫型、结节型、复杂型，其中结节型依回声及病理表现又分为脓性结节、钙化结节和干酪结节。结论弥漫型附睾结核容易累及睾丸，应早期手术；脓性结节以手术治疗为主；钙化结节无需手术；干酪结节先药物治疗，如效果不佳应手术治疗；复杂型必须手术治疗。超声首诊怀疑附睾结核时，系统扫查泌尿系有助于发现无症状的泌尿系结核。