Pediatric Clinic, University of Erlangen-Nuremberg, Erlangen, Germany.
Ultraschall Med. 2021 Feb;42(1):10-38. doi: 10.1055/a-1325-1834. Epub 2021 Feb 2.
Acute testicular pain in childhood can be caused by testicular torsion, torsion of the appendix testis, or epididymo-orchitis. Quick and reliable diagnosis is essential for determining the further course of action (surgery or conservative approach). The diagnostic tool of choice is high-resolution sonography with a linear transducer (> 10 MHz) combined with color and spectral Doppler sonography. The Doppler device settings should include a low pulse repetition frequency (< 4 cm/s), a low wall filter (< 100 Hz), and adequate gain. Comparison with the unaffected healthy testis is essential. The most important of the three diseases is torsion of the spermatic cord because it requires immediate surgical intervention and detorsion. The affected testis is enlarged and has an inhomogeneous echotexture with hypoechoic and hyperechoic areas as well as an associated hydrocele. In testicular torsion, color Doppler shows reduced or absent intratesticular vessels in comparison with the healthy contralateral testis. Spectral Doppler shows decreased flow velocities especially during diastole in intratesticular arteries and an increased resistance index. The investigation should always include imaging of the spermatic cord from the outer inguinal ring to the upper pole of the testis. In contrast to a normal finding, the vessels and the ductus deferens are not displayed as linear tubular structures but in form of a spiral twist. Ultrasound shows a target-like structure with multiple concentric rings. Color Doppler sonography shows the typical whirlpool sign. In torsion of the appendix testis, the appendix testis is enlarged in the groove between the testis and epididymis. The longitudinal diameter of the appendix testis can be greater than 5 mm. The echogenicity of the torsed appendage can vary between hypoechoic (acute torsion) and hyperechoic (prior torsion). An associated hydrocele of varying size is usually seen. Color Doppler sonography reveals a lack of perfusion of the enlarged appendix testis and increased vascularity of the testis and primarily the epididymis. Epididymo-orchitis is characterized by an enlarged epididymis and/or testis with inhomogeneous echogenicity (hypoechoic - hyperechoic). Color Doppler sonography shows increased vascularity in comparison with the unaffected testis. Spectral Doppler reveals increased diastolic flow velocities and a decreased resistance index. Idiopathic scrotal edema and an incarcerated inguinal hernia must be ruled out in the differential diagnosis.
儿童急性睾丸痛可由睾丸扭转、睾丸附件扭转或附睾炎引起。快速可靠的诊断对于确定进一步的治疗方案（手术或保守治疗）至关重要。首选的诊断工具是高频超声（＞10MHz）结合彩色和频谱多普勒超声。多普勒设备的设置应包括低脉冲重复频率（＜4cm/s）、低壁滤波器（＜100Hz）和适当的增益。与正常的健康睾丸进行比较是必不可少的。这三种疾病中最重要的是精索扭转，因为它需要立即手术干预和松解。受影响的睾丸增大，回声不均匀，有低回声和高回声区域以及伴随的鞘膜积液。在睾丸扭转中，与对侧健康睾丸相比，彩色多普勒显示睾丸内血管减少或消失。频谱多普勒显示睾丸内动脉收缩期血流速度降低，阻力指数增加。检查应始终包括从外环到睾丸上极的精索成像。与正常表现相反，血管和输精管不是以线性管状结构显示，而是呈螺旋扭曲。超声显示靶样结构，有多条同心环。彩色多普勒超声显示典型的漩涡征。在睾丸附件扭转中，睾丸附件在睾丸和附睾之间的凹槽中增大。睾丸附件的纵向直径可大于 5mm。扭转的附件回声强度可在低回声（急性扭转）和高回声（先前扭转）之间变化。通常可见大小不等的鞘膜积液。彩色多普勒超声显示增大的睾丸附件无灌注，睾丸和主要是附睾的血管增多。附睾炎的特征是附睾和/或睾丸增大，回声不均匀（低回声-高回声）。与正常睾丸相比，彩色多普勒超声显示血管增多。频谱多普勒显示舒张期血流速度增加，阻力指数降低。在鉴别诊断中，必须排除特发性阴囊水肿和嵌顿性腹股沟疝。
