Study Of The Value Of High Frequency Color Doppler Ultrasound In The Diagnosis Of Tuberculocele

Objective:To anlyze and summarize the ultrasonographic features of tuberculocele and to further investigate the application value of high frequency color Doppler ultrasound in the diagnosis of tuberculocele.Methods:Thirty-seven patients with tuberculocele confirmed by high frequency color Doppler ultrasound,surgical pathology,biopsy pathology and secretion smear from June 2006 to June 2017 were included in this study.A retrospective study was conducted to analyze and summarize the clinical parameters and ultrasonographic features of the 37 patients with tuberculocele.With onset age 17-67 years old,mean age(36±16.3)years old,course of disease one month to three years and mean course of disease(10±1.5)month.13 cases presented painless mass in scrotum,12 cases painful mass,7 cases bulging feeling,5 cases skin ulceration;29 cases of unilateral testicle disease(13 cases left,16 cases right),8 cases bilateral;32 cases were confirmed by sugery and pathology,4 cases secretion smear,1 case biopsy pathology;22 cases complicated with tuberculosis of epididymis,5 cases tuberculosis of epididymis and pulmonary tuberculosis,5 cases active pulmonary tuberculosis,3 cases tuberculous pleurisy,2 case cervical tuberculous lymphadenitis.The adopted ultrasound machines were as follows:Anatares Color Doppler ultrasound diagnostic machine with VFX 13-5 probe and a frequency of 5-10 MHZ from SIEMENS Germany;Color Doppler instrument Mylab90 with LA523 probe and a frequency of 5-10MHz from ESAOTE Italy;EPIQ 5 Color Doppler ultrasound diagnostic machine with L 12-5 probe and a frequency of 5-12MHz from PHILIPSNetherlands.Patients were maintained at supine position with full exposure of scrotum.Proper lift of penis to the lower abdominal wall was instructed to observe possible flushing skin,swelling and sinus tract of the scrotal wall.The examiner was required wearing sterile gloves when,examing the scrotum for basic information of the position,number,size,hardness,pain,and mobility of the focus.The scrotum was evenly applied with couplant,and the probe sheathed with plastic membrane,then gently set the probe on the scrotum.2-D ultrasound was first adopted for multifaceted double-sided contrast to examine scrotum and its content on both sides.The position,form,size,number,border,echo features,possible testicle hydrocele,cold abscess and sinus tract on scrotal wall were carefully examined and recorded.Color Doppler Flow Imaging(CDFI)was then used to observe blood flow inside and around the focus.Peak systolic velocity(PSV)and resistance index(RI)were meaured if blood flow were detected.Results:The accuracy rate of ultrasonic diagnosis was 91.9%(34/37),misdiagnosis rate 8.1%(3/37).2 cases presented on ultrasound testicular anthorisma,which was actually distributed small nodules but misdiagnosed as acute orchitis;1 case presented undefined low heterogeneous echo which was misdiagnosed as testicular seminoma.27 cases of tuberculocele complicated with tuberculosis of epididymis(73.0%,27/37),10 cases single tuberculocele(27.0%,10/37),which indicated that tuberculocele was maily developed from tuberculosis of epididymis.According to the ultrasonographic features,there are generally four types of the observed tuberculocele:(1)Diffuse nodules(22 cases,55.9%):diffuse enlargement of the testicle,heterogeneous echoes,defined edge,distributed hypoecho nodules with diameters of 2-5 mm,CDFI showed star-shaped colored blood flow signal or no signal,PSV13cm/s-15.5cm/s,RI:0.50-0.53.(2)Mass(3 cases,8.1%):single solid node or single mass with diameters of 12-21 mm was observed in the testicle,round or irregualr shaped,defined edge,heterogeneous echoes,tiny calcification focal,CDFI showed star-shaped blood flow signal,PSV16-23cm/s,RI0.47-0.55.(3)Abscess(7 cases,18.9%):swelling testicles,heterogeneous echoes,semi-round or irregular shaped cystic mass,defined edge,a partially thin or thick cystic wall,poor sound transmission,posterior echo enhancement,CDFI showed no obvious blood flow signal.(4)Sinus tract(5 cases,13.5%):swelling testicles,mix-echoed mass,irregular shaped,fluid area with poor transmisson and no echo,hypoecho area extended from tunica albuginea testis and scrotal wall to form sinus tract,undefined edge from testicular tissue,CDFI showed no blood flow signal.After partially pressured the probe,the light spot in no-echo area of the testicle mass moved and spilled outside the body surface through the sinus tract.Conclusion:high frequency color Doppler ultrasound can present the ultrasonographic and blood flow features of different types of tuberculocele,which is referential for clinical diagnosis and differential diagnosis of tuberculocele.