Vijayaraghavan S Boopathy
Sonoscan Ultrasonic Scan Centre, Coimbatore, India.
J Ultrasound Med. 2006 May;25(5):563-74. doi: 10.7863/jum.2006.25.5.563.
The purpose of this study was to prospectively investigate the role of high-resolution and color Doppler sonography in the differential diagnosis of acute scrotum and testicular torsion in particular.
Patients who underwent sonography for acute scrotum between April 2000 and September 2005 were included in the study. Gray scale and color Doppler sonography of the scrotum was performed. The spermatic cord was studied on longitudinal and transverse scans from the inguinal region up to the testis, and the whirlpool sign was looked for.
During this period, 221 patients underwent sonography for acute scrotum. Sixty-five had epididymo-orchitis with a straight spermatic cord, a swollen epididymis, testis, or both, an absent focal lesion in the testis, and increased flow on color Doppler studies along with the clinical features of infection. Three had testicular abscesses. Sonography revealed features of torsion of testicular appendages in 23 patients and acute idiopathic scrotal edema in 19. Complete torsion was seen in 61 patients who had the whirlpool sign on gray scale imaging and absent flow distal to the whirlpool. There was incomplete torsion in 4 patients in whom the whirlpool sign was seen on both gray scale and color Doppler imaging. Nine patients had segmental testicular infarction, and 1 had a torsion-detorsion sequence revealing testicular hyperemia. In 14 patients, the findings were equivocal. There was a complicated hydrocele, mumps orchitis, and vasculitis of Henoch-Schönlein purpura in 1 patient each. Five patients had normal findings. Fourteen were lost for follow-up.
Sonography of acute scrotum should include study of the spermatic cord. The sonographic real-time whirlpool sign is the most specific and sensitive sign of torsion, both complete and incomplete. Intermittent testicular torsion is a challenging clinical condition with a spectrum of clinical and sonographic features.
本研究旨在前瞻性地探讨高分辨率彩色多普勒超声在急性阴囊疾病鉴别诊断中的作用，尤其是在睾丸扭转诊断中的作用。
纳入2000年4月至2005年9月期间因急性阴囊疾病接受超声检查的患者。对阴囊进行灰阶及彩色多普勒超声检查。从腹股沟区至睾丸对精索进行纵切和横切扫查，观察有无漩涡征。
在此期间，221例患者因急性阴囊疾病接受了超声检查。65例为附睾炎，精索走行自然，附睾、睾丸或两者均肿大，睾丸内无局灶性病变，彩色多普勒检查血流增多，伴有感染的临床特征。3例为睾丸脓肿。23例患者超声显示睾丸附件扭转特征，19例为急性特发性阴囊水肿。61例患者在灰阶成像上出现漩涡征，漩涡远端无血流信号，提示睾丸完全扭转。4例患者在灰阶和彩色多普勒成像上均出现漩涡征，提示睾丸不完全扭转。9例患者为节段性睾丸梗死，1例患者出现扭转-复位序列，表现为睾丸充血。14例患者检查结果不明确。1例患者分别合并复杂鞘膜积液、流行性腮腺炎睾丸炎及过敏性紫癜性血管炎。5例患者检查结果正常。14例患者失访。
急性阴囊超声检查应包括精索检查。超声实时漩涡征是睾丸完全扭转和不完全扭转最具特异性和敏感性的征象。间歇性睾丸扭转是一种具有挑战性的临床病症，具有一系列临床和超声特征。
