Yagil Yael, Naroditsky Inna, Milhem Jumana, Leiba Ronit, Leiderman Maxim, Badaan Shadie, Gaitini Diana
Department of Medical Imaging, Rambam Health Care Campus, PO Box 9602, Ha'Aliya St 8, 31096 Haifa, Israel.
J Ultrasound Med. 2010 Jan;29(1):11-21. doi: 10.7863/jum.2010.29.1.11.
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.
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.
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.
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.
本研究旨在探讨阴囊多普勒超声检查（DUS）作为主要术前诊断工具在急诊科（ED）就诊的急性阴囊患者中的分诊作用。
纳入在3年期间（2004 - 2007年）因急性阴囊到ED就诊并在超声科接受阴囊DUS检查的患者。回顾性收集并分析患者特征、DUS检查结果及临床处理情况。将接受探查患者的多普勒超声诊断结果与组织病理学结果进行比较，将接受药物治疗患者的多普勒超声诊断结果与出院时的最终诊断进行比较。
共纳入620例连续患者，进行了669次DUS检查。最常见的阴囊DUS诊断为附睾炎、鞘膜积液、精索静脉曲张和睾丸炎。77例存在阴囊外伤。155例患者在ED初步评估后住院；68例接受了手术。超声怀疑20例患者存在睾丸扭转，其中18例得到证实。13例患者偶然诊断为阴囊恶性肿瘤，8例为睾丸血肿。多普勒超声诊断睾丸扭转的敏感度为94%，特异度为96%，准确率为95.5%，阳性预测值（PPV）为89.4%，阴性预测值（NPV）为98%。多普勒超声诊断睾丸恶性肿瘤的敏感度为92%，特异度为95%，准确率为94%，PPV为78.5%，NPV为98%。
阴囊DUS是一种高度敏感的术前诊断工具，从而证实了其在ED就诊的急性阴囊患者初始分诊中的常规应用价值。
