Learch T J, Hansch L P, Ralls P W
Department of Radiology, Olive View/UCLA Medical Center, Fylmar 91342, USA.
AJR Am J Roentgenol. 1995 Oct;165(4):879-83. doi: 10.2214/ajr.165.4.7676986.
The purposes of this study were to characterize sonographic findings in patients with scrotal injuries caused by gunshot wounds and to determine if sonography can be used to detect and differentiate various scrotal abnormalities. If patients are managed conservatively, less serious injuries (hydroceles, hematoceles, and scrotal hematomas) must be separated from those requiring urgent surgical repair (testicular rupture).
Sonograms obtained in 19 patients to evaluate gunshot wounds to the scrotum were studied for evidence of testicular rupture, extratesticular soft-tissue abnormalities, and the presence and location of foreign bodies. The results were compared with clinical (19 patients) and surgical (six patients) findings.
Retrospective review of the sonograms showed normal testicles without evidence of rupture in 11 patients, eight of whom had scrotal hematomas, hydroceles, or hematoceles. Nine of the 11 patients were treated conservatively, and their symptoms resolved. In one of the other two patients, a prominent vessel was initially mistaken for a fracture plane; the testicle was found to be intact at surgery. The other patient was taken to surgery to remove a bullet in the peritesticular soft tissues; surgery demonstrated intact, viable testicles bilaterally, but both epididymides had through-and-through tracts from the bullet. Two patients had sonolucent tracks from missile pathways in otherwise normal appearing testicles. Testicular rupture was sonographically detected in six patients. Sonograms in all patients with surgically confirmed testicular rupture showed heterogeneous echogenicity and loss of smooth oval contour. In one patient, the sonogram showed a fracture plane. Sonograms showed foreign bodies in five patients and localized them to the testicular parenchyma (one patient) and to extratesticular soft tissues (four patients).
Sonography can distinguish various scrotal abnormalities caused by ballistic trauma, information that can be useful to the urologist if conservative management is considered. Sonography can be used to distinguish less serious injuries such as scrotal hematomas, hydroceles, and hematoceles from surgical emergencies such as testicular rupture. Foreign body presence and location can also be determined. Epididymal injuries were not well visualized.
本研究的目的是描述枪伤所致阴囊损伤患者的超声检查结果，并确定超声检查是否可用于检测和鉴别各种阴囊异常情况。如果对患者采取保守治疗，必须将不太严重的损伤（鞘膜积液、积血和阴囊血肿）与需要紧急手术修复的损伤（睾丸破裂）区分开来。
对19例因阴囊枪伤而进行超声检查的患者的超声图像进行研究，以寻找睾丸破裂、睾丸外软组织异常以及异物存在和位置的证据。将结果与临床（19例患者）和手术（6例患者）结果进行比较。
对超声图像的回顾性分析显示，11例患者的睾丸正常，无破裂迹象，其中8例有阴囊血肿、鞘膜积液或积血。11例患者中有9例接受了保守治疗，症状得到缓解。在另外2例患者中，有1例最初将一条明显的血管误认为骨折平面；手术时发现睾丸完整。另1例患者接受手术取出睾丸周围软组织中的子弹；手术显示双侧睾丸完整、存活，但双侧附睾均有子弹造成的贯通伤道。2例患者在外观正常的睾丸中可见导弹行径的无回声区。超声检查发现6例患者存在睾丸破裂。所有经手术证实睾丸破裂的患者的超声图像均显示回声不均匀，椭圆形轮廓失去光滑度。1例患者的超声图像显示有骨折平面。超声图像显示5例患者有异物，并确定异物位于睾丸实质（1例患者）和睾丸外软组织（4例患者）。
超声检查可鉴别弹道创伤所致的各种阴囊异常情况，这一信息对考虑采取保守治疗的泌尿外科医生可能有用。超声检查可用于将阴囊血肿、鞘膜积液和积血等不太严重损伤与睾丸破裂等手术急症区分开来。还可确定异物的存在和位置。附睾损伤的显示效果不佳。
