Orazi C, Schingo P, Ferro F, Vacca P, Spagnoli A, Fariello G
Servizio di Radiologia, IRCCS Roma.
Radiol Med. 1997 Dec;94(6):646-51.
Acute scrotum in the pediatric age is mainly related to surgical causes. Spermatic cord torsion and inguinoscrotal hernia must be ruled out first, because of the possible ischemic damage to gonadal tissue and therefore surgery is sometimes performed directly, thus representing also a diagnostic tool. Spermatic cord torsion is found in two age ranges, namely: the neonatal period, where it usually represents the evolution of an intrauterine process, and the peripubertal period, which is more frequent. An unquestionable and prompt diagnosis is particularly needed because of the extreme sensitivity of gonadal tissue to ischemia. In this particular field, color and power Doppler US, depicting gonadal flow, have greatly increased diagnostic imaging capabilities, which were previously limited to B-mode US.
We examined 19 peripubertal patients with the diagnosis of spermatic cord torsion made on the basis of B-mode US and then confirmed with color Doppler.
We found two signs which can be considered highly suggestive of spermatic cord torsion: the spiral twist of spermatic vessels and the peculiar extent of reactive hydrocele, caused by the bell clapper anomaly of the vaginal sac.
The above US patterns are very helpful to diagnose spermatic cord torsion.
小儿急性阴囊主要与外科病因有关。必须首先排除精索扭转和腹股沟阴囊疝，因为可能会对性腺组织造成缺血性损伤，因此有时会直接进行手术，手术也因此成为一种诊断手段。精索扭转见于两个年龄段，即：新生儿期，通常是宫内过程的演变；青春期前期，较为常见。由于性腺组织对缺血极度敏感，因此尤其需要明确且迅速的诊断。在这个特定领域，能够显示性腺血流的彩色和能量多普勒超声极大地提高了诊断成像能力，而此前仅限于B超。
我们检查了19例青春期前期诊断为精索扭转的患者，最初基于B超诊断，后经彩色多普勒确诊。
我们发现两个高度提示精索扭转的征象：精索血管的螺旋状扭曲以及由鞘膜囊的钟摆样畸形引起的反应性鞘膜积液的特殊范围。
上述超声表现对诊断精索扭转非常有帮助。
