Karmazyn Boaz, Steinberg Ran, Kornreich Liora, Freud Enrique, Grozovski Sylvia, Schwarz Michael, Ziv Nitza, Livne Pinchas
Department of Pediatric Radiology, Schneider Children's Medical Center of Israel, Petah-Tiqva, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
Pediatr Radiol. 2005 Mar;35(3):302-10. doi: 10.1007/s00247-004-1347-9. Epub 2004 Oct 16.
Diagnosis of testicular torsion in children is challenging, as clinical presentation and findings may overlap with other diagnoses.
To define the clinical and ultrasound criteria that best predict testicular torsion.
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).
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 < or =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.
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.
儿童睾丸扭转的诊断具有挑战性，因为临床表现和检查结果可能与其他诊断重叠。
确定最能预测睾丸扭转的临床和超声标准。
回顾1997年至2002年因急性阴囊住院的儿童记录。将最终诊断为睾丸扭转的儿童的临床和超声检查结果与其他诊断（睾丸附件扭转、附睾炎和附睾睾丸炎）的儿童进行比较。
41名儿童患有睾丸扭转；131名患有其他诊断。逐步回归分析得出与睾丸扭转显著相关的三个因素：疼痛持续时间≤6小时；提睾反射缺失或减弱；睾丸弥漫性压痛。当根据这些因素的存在情况（0 - 3分）对儿童进行最终诊断评分时，得分为0的儿童均无睾丸扭转，而得分为3的儿童中有87%患有睾丸扭转。睾丸血流减少或消失的超声检查结果敏感性为63%，特异性为99%。10名睾丸扭转且睾丸血流正常或增加的儿童中有8名超声显示精索扭转。
我们建议所有急性阴囊疼痛且临床评分为3分的儿童应接受睾丸探查，睾丸扭转可能性较低（评分1或2分）的儿童应首先进行诊断性超声检查。由于睾丸血流存在并不排除扭转，所有急性阴囊且睾丸血流正常或增加的儿童都应仔细评估精索。
