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Hodentorsion: Diagnose, Differenzialdiagnose und Therapie im Kindesalter

Testicular torsion: diagnosis, differential diagnosis, and treatment in children

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Zusammenfassung

Das akute Skrotum ist eine Notfallsituation, wobei in weniger als 20% der Fälle eine Hodentorsion vorliegt. Inzwischen hat sich die Sonographie zur entscheidenden diagnostischen Untersuchungsmodalität entwickelt deren zunehmende Anwendung zu technischen Fortschritten der Ultraschalldiagnostik, zu einer kritischen Bewertung von Ultraschallkriterien zum Ausschluss einer Hodentorsion und zu einer Standardisierung der Untersuchungsabläufe geführt hat. Die in der Dopplersonographie dargestellte seitengleiche zentrale arterielle und venöse Perfusion ist hierbei das wichtigste Kriterium zum Ausschluss einer Torsion.

Weitere Kriterien wie „resistant index“, Parenchymstruktur des Hodens im Seitvergleich, Nachweis eines torquierten Samenstrangs oder seitendifferente Perfusion des Hodenparenchyms werden erörtert und auf die Schwierigkeiten bei der partiellen und intermittierenden Hodentorsion hingewiesen. Alternative Untersuchungsmethoden und die Bedeutung der Sonographie zur Klärung weiterer Ursachen in der Differenzialdiagnose des akuten Skrotums werden aufgezeigt. Zusammenfassend gelingt durch die gemeinsame Betrachtung von B-Mode-Bildgebung, Farbdoppler- und Powerdopplersonographie sowie der Analyse der Doppler-Fluss-Kurven nach klinischer Untersuchung die geforderte umfassende Beurteilung des Hodens beim akuten Skrotum des Jungen.

Abstract

Acute scrotum represents an emergency situation although testicular torsion is present in less than 20% of the cases. Sonography has meanwhile become the definitive modality for diagnosis. Its increasing use before surgical intervention has led to technical improvements in ultrasound diagnostics and critical assessment of ultrasound criteria to exclude testicular torsion as well as standardization of examination procedures. Central arterial and venous perfusion shown to be bilaterally equal on Doppler sonography is the most important criterion for excluding torsion.

This article discusses other criteria such as the “resistance index,” comparison of parenchymal structure of both testes, evidence for spermatic cord torsion, or differences between the sides in perfusion of the testicular parenchyma and highlights the difficulties involved in partial and intermittent testicular torsion. Alternative investigative methods and the significance of sonography in the differential diagnosis of other underlying causes are addressed. In summary, the combination of interpreting B-mode imaging, color Doppler, and power Doppler sonography and analyzing Doppler flow curves after clinical examination results in successful and conclusive evaluation of the testes in cases of acute scrotum in boys.

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Authors and Affiliations

  1. Abt. Kinderchirurgie, Chirurgische Universitätsklinik Heidelberg

    P. Günther

  2. Pädiatrische Radiologie, Universitätsklinikum Heidelberg

    J.-P. Schenk

  3. Abteilung Kinderchirurgie, Chirurgische Universitätsklinik, Im Neuenheimer Feld 110, 69120 , Heidelberg

    P. Günther

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Correspondence to P. Günther.

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Günther, P., Schenk, JP. Hodentorsion: Diagnose, Differenzialdiagnose und Therapie im Kindesalter. Radiologe 46, 590–595 (2006). https://doi.org/10.1007/s00117-005-1256-4

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  • DOI: https://doi.org/10.1007/s00117-005-1256-4

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