Pryor J L, Watson L R, Day D L, Abbitt P L, Howards S S, Gonzalez R, Reinberg Y
Department of Urologic Surgery, University of Minnesota, Minneapolis.
J Urol. 1994 Mar;151(3):693-7. doi: 10.1016/s0022-5347(17)35051-6.
There is an increased use of scrotal ultrasound in the clinician's office and emergency room for the investigation of scrotal pain. The use of real-time scrotal ultrasound for the diagnosis of testicular torsion has been described in the literature. A false-negative ultrasound examination can postpone the diagnosis of torsion and result in testicular loss. We examined 6 patients 1 day to 18 years old who had subacute testicular torsion with scrotal symptomatology (pain and/or swelling) for longer than 8 hours (range 12 hours to 6 days). Scrotal ultrasound was performed as 1 of the initial tests. A common sonographic pattern was an inhomogeneous testicle with hypoechoic areas alternating with hyperechoic areas and thickening of adjacent scrotal tissue. Another common finding was an edematous hyperechoic epididymis and a small hydrocele. In 4 of the 6 cases these nonspecific findings suggested a misleading diagnosis of tumor or epididymitis and resulted in delay of surgery and testicular loss. Treatment was not delayed in only 2 patients in whom the diagnosis of torsion was made initially by history and physical examination, and ultrasound was done for interest only. Misdiagnosis of intratesticular blood flow and some potential pitfalls of scrotal imaging by color Doppler ultrasound are discussed. We conclude that real-time scrotal sonography can be misleading in cases of subacute testicular torsion and, therefore, it should not be used in this clinical setting.
临床医生办公室和急诊室越来越多地使用阴囊超声来检查阴囊疼痛。文献中已描述了使用实时阴囊超声诊断睾丸扭转。超声检查假阴性可能会延迟扭转的诊断并导致睾丸丧失。我们检查了6例年龄在1天至18岁之间的患者，这些患者患有亚急性睾丸扭转并伴有阴囊症状（疼痛和/或肿胀）超过8小时（范围为12小时至6天）。阴囊超声作为初始检查之一进行。常见的超声图像表现为睾丸不均匀，低回声区与高回声区交替出现，相邻阴囊组织增厚。另一个常见发现是附睾水肿呈高回声以及少量鞘膜积液。6例中有4例这些非特异性表现提示误诊为肿瘤或附睾炎，导致手术延迟和睾丸丧失。仅2例患者治疗未延迟，这2例最初通过病史和体格检查诊断为扭转，超声检查仅作为兴趣检查。本文讨论了睾丸内血流的误诊以及彩色多普勒超声阴囊成像的一些潜在陷阱。我们得出结论，实时阴囊超声检查在亚急性睾丸扭转病例中可能会产生误导，因此，在这种临床情况下不应使用。
