干酪样坏死性附睾结核声像图特征分析

Sonographical Features of the Epididymis Tuberculosis with Caseous Necrosis

目的:总结干酪样坏死性附睾结核高频彩色多普勒声像图特征,提高其超声诊断准确率。方法:对12例经手术及病理证实的干酪样坏死性附睾结核高频彩色多普勒检查结果及临床资料进行回顾性分析,同时与28例附睾炎资料对比并进行文献复习。结果:①12例患者结核菌素(PPD)试验阳性67%,患肺结核42%。②干酪样坏死性附睾结核高频声像图特征:附睾局部或全部肿大,外形失常,病变处呈不规则、不均质中等偏强或低回声,兼有局限性较小的不规则、均质低或无回声区,边界不清;高频彩色多普勒能量图:部分患者(33%)病灶见丰富或较丰富以动脉为主的动、静脉血流信号。③继发改变:干酪样坏死性附睾结核者患侧睾丸肿大,内回声增强,可有睾丸鞘膜积液,无阴囊壁增厚及腹股沟淋巴结肿大,不伴有精索静脉曲张。结论:干酪样坏死性附睾结核高频彩色多普勒声像图具有一定特征,超声对其诊断及鉴别诊断具有重要临床意义。

Objective ： To analyse sonographical features of epididymis tuberculosis with caseous necrosis and improve the accuracy of ultrasonic diagnosis. Methods： Ultrasonic features of 12 cases with epididymis tuberculosis with caseous necrosis, confirmed by surgical pathology, was retrospectively analysed： size, location, echogenicity, degree of blood flow in the lesion. Results： In all 12 patients, the number of purified protein derivative test （PPD） presenting the positive reached to 67% , while cases with the pulmonary tuberculosis was 42%. The epididymal tuberculosis with caseous necrosis could present images of the whole or focal epididymal enlargement and abnormal shape. The lesion＇s internal echoes were irregular, inhomogenous increased isoechoic echogenicity or hypoecholc, including bad-defined, irregular, homogenous hypoechoic or anechoic. In lesional location, 4 out of 12 patients （33%） possessed richly color blood flow in Color Doppler Power Imaging（CDPI）. The testicular enlargement with increased internal echoes and the testicular hydroceles were partly（ 58% , 7/12） observed by ultrasound. There was no varicocele, scrotal wall thickening and inguinal lymph node enlargement. Conclusion ： The High Frequency Color Doppler images is helpful for the diagnosis and differential diagnosis of epididymis tuberculosis with caseous necrosis. Natl J Androl,2005 ,11 （ 12 ） ：912-914,917