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Title: [High-frequency ultrasonography for diagnosis and differential diagnosis of acute scrotum in children].
Author: Xu YF, Jiang HY, Hu HY, Wang HR, Geng TX, Pan HR, Li XX.
Journal: Zhonghua Nan Ke Xue; 2016 Nov; 22(11):996-1000. PubMed ID: 29281207.
Abstract:
OBJECTIVE: To analyze the high-frequency ultrasound image features of acute scrotum in children and explore the value of high-frequency ultrasonography in the diagnosis and differential diagnosis of the disease. METHODS: This retrospective study included 256 children aged 2 days to 14 years undergoing color Doppler ultrasonography at 2 hours to 3 days after onset of acute scrotum. We analyzed the morphology, internal echo and blood supply of the testis in comparison with the clinical and pathological results. RESULTS: Among the 256 cases, acute testicular torsion was found in 23, of which 16 were treated by complete resection the necrotic testis and the other 7 by surgical reduction of testicular torsion. Ultrasonographically, the involved testes presented different degrees of increase or decrease in volume, with uneven internal echoes, irregular hypoechoic flakes, and testicular hydrocele. Color Doppler flow imaging (CDFI) showed significant blood flow signals around the diseased testes but none within them. Acute testicular appendix torsion was found in 116 cases, in which ultrasonography manifested nodules with round or oval abnormal echoes between the upper pole of the testis and caput epididymidis, first hypoechoic and then gradually increased, heterogeneous internally. CDFI revealed enlarged epididymides and enriched testicular blood flow but no blood flow signals in the nodules. The 103 cases of acute epididymitis were ultrasonographically characterized by varied degrees of swelling of the involved epididymis with uneven internal echoes and rich blood flow signals on CDFI. Six of the cases were diagnosed as acute orchitis, with the ultrasonographic features of testicular swelling and low but uniform internal echoes, with rich blood flow signals on CDFI. Incarcerated inguinal hernia was confirmed in 15 cases, in which ultrasonography revealed intrusion of the hernia into the obviously enlarged scrotal sac with the mesentery and intestine in it, and blood flow visible on CDFI. Acute scrotal wall hematoma and edema was found in 8 cases, with the ultrasonographic characteristics of scrotal wall thickening, with visible blood flow signals on CDFI. CONCLUSIONS: High-frequency ultrasonography has a high sensitivity and specificity for acute scrotum in children, which can be applied as the first-choice clinical imaging modality and provide reliable evidence for the diagnosis and differential diagnosis of the disease. 目的: 分析小儿阴囊急症的高频超声图像特征，探讨高频彩超对小儿阴囊急症的诊断及鉴别诊断价值。方法: 回顾分析我院2014年1月至2016年1月因阴囊急症而行彩色多普勒血流显像（CDFI）检查的256例患儿( 起病时间2 h至3 d，年龄2 d至14岁) 睾丸的形态、结构、内部回声及血供情况，并与临床手术及病理结果进行对照分析比较。结果: 256例阴囊急症患儿中急性睾丸扭转23例，其中16例患儿行坏死睾丸切除术,有12例行对侧睾丸固定术；7例患儿行扭转睾丸复位，予保留并行睾丸固定术。超声特征：患儿患侧睾丸不同程度增大或缩小，内部回声不均匀，可见不规则片状低回声，可伴有睾丸鞘膜积液。CDFI：患侧睾丸内无明显血流信号，周围血流信号丰富。急性睾丸附件扭转116例，超声特征：睾丸上极上方或睾丸上极与附睾头间类圆形或椭圆形异常回声结节，早期为低回声，后逐渐增高，内部回声不均匀，呈“网格样”。附睾增大，可伴有患侧睾丸增大、阴囊壁增厚。CDFI：增大附睾或睾丸血流丰富，结节内未见血流信号。急性附睾炎103例，超声特征：患儿患侧附睾明显不同程度肿大，内部回声不均匀，CDFI：患侧附睾内血流信号丰富。急性睾丸炎6例，超声特征：患侧睾丸肿大，内部回声呈低回声，回声尚均匀。CDFI:患侧睾丸内部血流丰富。腹股沟嵌顿疝15例，超声特征：可见疝囊突入阴囊，阴囊明显增大，其内可见肠系膜及肠管。CDFI：可见血流信号。急性阴囊壁血肿及水肿8例。超声特征：阴囊壁均匀或不均匀增厚。CDFI；阴囊壁可见血流信号。结论：高频彩超对小儿阴囊急症具有较高敏感性及特异性，可为临床医生诊断及鉴别诊断提供可靠的诊断依据，是临床首选的影像学检查方法。.

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