Mertiri Livja, Bih Eric, Ketwaroo Pamela, Munden Martha M, Zuniga Zachary V, Mahmood Nadia, Ngan Esther, Kan J Herman
Edward B. Singleton Department of Radiology, Texas Children's Hospital and Baylor College of Medicine, 6701 Fannin Street, Houston, TX 77030, USA.
Edward B. Singleton Department of Radiology, Texas Children's Hospital and Baylor College of Medicine, 6701 Fannin Street, Houston, TX 77030, USA.
Clin Imaging. 2025 Sep;125:110566. doi: 10.1016/j.clinimag.2025.110566. Epub 2025 Jul 26.
Testicular torsion is a surgical emergency. We have observed that mass-like epididymal enlargement and morphologic changes to the testicular parenchyma differentially represent testes that are viable versus non-viable at the time of scrotal exploration.
The purpose of this study is to assess sonographic findings that may help predict the viability of torsed testes at the time of scrotal exploration.
We retrospectively reviewed 128 scrotal ultrasound exams of surgically confirmed testicular torsions (88 salvageable, 40 non-salvageable) from July 2022 to July 2023 (mean age 13.1 years, range: 1-19 years). We assessed the visibility of the mediastinum testis, the ratio between affected and non-affected testes of the maximal cross-sectional area of the epididymis on a transverse plane, the ratio between affected and non-affected testes of the testicular volume, and subjective evidence of mass-like epididymal enlargement.
Patients with global epididymal enlargement and those with a non-visible mediastinum testis were found to have a statistically higher likelihood of non-salvageable testes (p = 0.0123 and p = 0.0208, respectively). Additionally, a significant association was observed between testicular volume symmetry and the viability of torsed testes (p = 0.0013). Notably, when the volume of the torsed testis exceeded that of the normal contralateral testis by 40 %, it was significantly associated with a non-salvageable outcome (p = 0.0132).
Sonographically visible mediastinum testis, absence of epididymal tail enlargement, and similar volume between affected and non-affected testes are potential positive predictors of the viability of the pediatric torsed testes found during emergent testicular salvage surgery. In contrast, the absence of these predictors suggests a non-salvageable testis.
睾丸扭转是一种外科急症。我们观察到，在阴囊探查时，附睾呈肿块样肿大以及睾丸实质的形态学改变分别代表了可存活与不可存活的睾丸。
本研究的目的是评估超声检查结果，这些结果可能有助于预测阴囊探查时扭转睾丸的存活情况。
我们回顾性分析了2022年7月至2023年7月期间128例经手术证实为睾丸扭转的阴囊超声检查（88例可挽救，40例不可挽救）（平均年龄13.1岁，范围：1 - 19岁）。我们评估了睾丸纵隔的可见性、横断面上附睾最大截面积的患侧与健侧睾丸之比、睾丸体积的患侧与健侧睾丸之比以及附睾呈肿块样肿大的主观证据。
发现附睾整体肿大的患者和睾丸纵隔不可见的患者，其睾丸不可挽救的可能性在统计学上显著更高（分别为p = 0.0123和p = 0.0208）。此外，观察到睾丸体积对称性与扭转睾丸的存活情况之间存在显著关联（p = 0.0013）。值得注意的是，当扭转睾丸的体积超过正常对侧睾丸40%时，与不可挽救的结果显著相关（p = 0.0132）。
超声可见睾丸纵隔、附睾尾部无肿大以及患侧与健侧睾丸体积相似是急诊睾丸挽救手术中发现的小儿扭转睾丸存活的潜在阳性预测指标。相反，缺乏这些预测指标提示睾丸不可挽救。
