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Emergency Ultrasound (EUS)教學(19)

急診超音波在睪丸急症之應用
新光醫院急診醫學科
陳國智醫師
中華民國醫用超音波學會指導醫師
Normal anatomy of the testis

Testis: (L) 3-5 cm; (W) & (AP) 2-3 cm


Epididymal head: < 1 cm
J Clin Ultrasound;2010:38:21–37
Normal scrotal anatomy and
ultrasonographic appearance
Homogeneous testicular
echogenicity and echo texture Testicular blood flow

J Ultrasound Med;2002: 21:171–185


Normal tunica albuginea

Bhatt S , Dogra V S Radiographics 2008;28:1617-1629

© 2008 by Radiological Society of North America


Mediastinum testis

J Clin Ultrasound;2010:38:21–37
Intratesticular artery

J Ultrasound Med;2002: 21:171–185


Normal testicular comparison

J Ultrasound Med;2002: 21:171–185


Normal epididymis

Radiographics. 2007;27:357-69
Color Doppler_head of the
epididymis

J Ultrasound Med;2002: 21:171–185


Appendix
Appendix testis Appendix epididymis

J Ultrasound Med;2002: 21:171–185


VARICOCELE

J Clin Ultrasound;2010:38:21–37
Varicocele

J Ultrasound Med;2002: 21:171–185


Varicocele in a 15-year-old boy

Radiographics. 2005;25:1197-214
Maldescent or Cryptorchidism
• Undescended testis
– inguinal canal 80%
– Abdomene 20%

• Infertility and cancer

• US
– preoperative
localization

J Clin Ultrasound;2010:38:21–37
Undescended testes in a 36-year-old man
Oval shaped, hypoechoic testis in inguinal canal

Radiology. 2003;227:18-36
HYDROCELE

J Clin Ultrasound;2010:38:21–37
Torsion
Most common: 12-18 years
Golden hours: 6 hours

J Clin Ultrasound;2010:38:21–37
Testicular torsion

J Ultrasound Med;2002: 21:171–185


Testicular torsion

J Ultrasound Med;2002: 21:171–185


Testicular torsion in a newborn with
right testicle discoloration at birth

Radiographics. 2005;25:1197-214
Testicular torsion in a 13-year-old
boy

Radiographics. 2005;25:1197-214
15M with left scrotal pain for 6hrs
Testicular torsion in a 12-year-old boy
with right-sided scrotal pain of sudden
onset

Radiographics. 2005;25:1197-214
Normal and twisted testicular appendages

Radiographics. 2005;25:1197-214
Epididymo-orchitis

J Clin Ultrasound;2010:38:21–37
Epididymitis

Surgical diagnosis: Epididymal abscess


J Clin Ultrasound;2010:38:21–37
Epididymitis

J Ultrasound Med;2002: 21:171–185


Epididymo-orchitis

J Ultrasound Med;
2002: 21:171–185
Epididymitis in an 11-year-old boy

Radiographics. 2005;25:1197-214
29M with painful left scrotum
Pyocele

J Ultrasound Med;2002: 21:171–185


Scrotal hematoma

J Ultrasound Med;2002: 21:171–185


Ruptured testicle after trauma

J Ultrasound Med;2002: 21:171–185


Fournier gangrene

Radiology. 2003;227:18-36
Inguinal hernia

J Ultrasound Med;2002: 21:171–185


Inguinal hernia
Inguinoscrotal hernia
5-month-old boy with scrotal
swelling

Radiographics. 2005;25:1197-214
Scrotal edema

J Clin Ultrasound;2010:38:21–37
Microlithiasis

J Ultrasound Med;2002: 21:171–185


Testicular rupture

Bhatt S , Dogra V S Radiographics 2008;28:1617-1629


Intratesticular hematomas
Immediately after trauma
Heterogeneous echotexture F/U US 12 hours later

Bhatt S , Dogra V S Radiographics 2008;28:1617-1629


Testicular rupture

Bhatt S , Dogra V S Radiographics 2008;28:1617-1629


Intratesticular hematoma

Bhatt S , Dogra V S Radiographics 2008;28:1617-1629

© 2008 by Radiological Society of North America


Testicular fracture

Bhatt S , Dogra V S Radiographics 2008;28:1617-1629

© 2008 by Radiological Society of North America


Testicular torsion

Bhatt S , Dogra V S Radiographics 2008;28:1617-1629

© 2008 by Radiological Society of North America


Infected testicular hematoma

Bhatt S , Dogra V S Radiographics 2008;28:1617-1629


Testicular pseudoaneurysm

Bhatt S , Dogra V S Radiographics 2008;28:1617-1629

© 2008 by Radiological Society of North America


Gunshot wounds to the testis

Bhatt S , Dogra V S Radiographics 2008;28:1617-1629


Hematocele

Bhatt S , Dogra V S Radiographics 2008;28:1617-1629

© 2008 by Radiological Society of North America


Hematoma after inguinal herniorrhaphy

Bhatt S , Dogra V S Radiographics 2008;28:1617-1629


Scrotal wall hematoma

Bhatt S , Dogra V S Radiographics 2008;28:1617-1629

© 2008 by Radiological Society of North America


Traumatic epididymitis

Bhatt S , Dogra V S Radiographics 2008;28:1617-1629


Henoch-Scho¨nlein purpura in a 9-
year-old boy with bilateral scrotal pain
and swelling

Bilateral scrotal wall thickening,


epididymal enlargement,
and reactive hydrocele
Radiographics. 2005;25:1197-214
Testicular torsion

J Ultrasound Med 2010; 29:11–21


Acute myeloid leukemia spread to the testis

J Ultrasound Med 2010; 29:11–21


J Ultrasound Med 2010; 29:11–21
Take Home Message
• 如果可能,選擇線形高解析探頭
• 善用Doppler的功能
• Testis注意
– Smooth outline
– Isoechoic echotexture
– Adequate internal flow
• 主要用來輔助Acute painful or swollen scrotum
– Torsion
– Epididymo-orchitis
– Trauma-related complications
– Obscure hernia