造影MRIが術前診断に有用であった精巣梗塞の2例

Abstract

症例1:16歳, 男児, 左陰嚢腫大及び発熱を主訴とし, 白血球増多及びCRPの上昇を認めた.造影MRIで左精巣は全く造影されず左精巣梗塞と診断し手術を行った.左精巣は出血性壊死に陥っており摘除, 右精巣固定術も施行した.症例2:12歳, 男児, 左陰嚢腫大及び発熱を主訴とし, 白血球増多及びCRPの上昇を認めた.造影MRIにて左精巣は造影され氏, 左精巣周囲は著明に造影され左精巣梗塞と断定し手術を行った.左精索は鞘膜内で360度回転していた.捻転を解除したが, 精巣の色調は改善せず, 左精巣は摘除, 右精巣は固定術を施行した

The differential diagnosis in acute scrotum, particularly torsion of spermatic cord and epididymitis, is sometimes difficult. An erroneous diagnosis may result in unnecessary and improper treatment. We report two cases of testicular infarction including torsion of spermatic cord, preoperatively diagnosed by enhanced magnetic resonance imaging (MRI). Case 1: A 16-year-old boy presented with a 3-day history of left scrotal swelling and left lower abdominal pain. He had fever and leukocytosis. Antibiotics for 2 days failed to relieve the symptoms. Enhanced MRI showed absence of blood flow in the left testis. Scrotal exploration revealed hemorrhage and necrosis in the left testis. Left orchiectomy and right orchiopexy were performed. Case 2: A 12-year-old boy visited with scrotal swelling and fever 30 hours after an acute onset of left scrotal pain. Enhanced MRI showed absence of blood flow in the left testis. Exploration revealed left necrotic testis with torsion of spermatic cord. Left orchiectomy and right orchiopexy were performed. Our two cases suggested that enhanced MRI, by which the intratesticular blood flow can be evaluated, may be useful for the diagnosis of testicular infarction.