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目的提高对睾丸感染性和肿瘤性病变的CT认识及诊断、鉴别诊断能力。方法回顾性分析经病理证实的40例睾丸感染性和肿瘤性病变患者的临床和CT资料。结果睾丸化脓性炎症8例,3例合并脓肿形成。CT表现为患侧睾丸明显肿大,实质内密度明显减低,增强扫描睾丸内坏死液化区无强化,周围包膜明显环形强化,同时累及附睾和周围皮肤软组织。睾丸结核7例,2例合并结核性脓肿形成。CT表现为患侧睾丸肿大,形态不规则,实质密度不均,可见结节及坏死区,增强扫描实性结节持续明显强化,合并脓肿者可见多发环状厚壁强化,与附睾及阴囊隔粘连、分界不清。睾丸肿瘤25例,精原细胞瘤(13例)CT表现为患侧睾丸稍低密度的均匀或不均匀密度肿块影,轻中度持续强化,散在少许坏死;淋巴瘤(4例)表现为边界清楚的类圆形睾丸肿块,密度均匀,呈中度均匀强化;另有腺泡状横纹肌肉瘤2例,畸胎瘤1例,表皮样囊肿1例,内胚窦瘤2例,胚胎性癌1例,神经内分泌癌1例。结论睾丸感染性病变(化脓性炎症、结核)和肿瘤性病变的CT表现具有一定的特征性,结合临床表现如发病时间、年龄、血清肿瘤标志物等有助于正确诊断和鉴别。
Objective To improve the testicular infection and neoplastic lesions of CT and diagnosis, differential diagnosis. Methods The clinical and CT data of 40 patients with pathologically confirmed testis infection and neoplastic lesions were retrospectively analyzed. Results of testicular suppurative inflammation in 8 cases, 3 cases of abscess formation. CT showed ipsilateral testis was significantly enlarged, significantly reduced the inner density, enhancement of testicular necrosis liquefied area without enhancement, the surrounding envelop significantly ring-shaped enhancement, while involving the epididymis and surrounding skin and soft tissue. Testicular tuberculosis in 7 cases, 2 cases of tuberculous abscess formation. CT showed ipsilateral testicular enlargement, irregular shape, uneven density, visible nodules and necrotic area, enhanced scan solid nodules continued to be significantly enhanced with multiple abscess were seen ring thick wall enhancement, and epididymal and scrotal septum Adhesion, the boundary is unclear. Testicular tumor in 25 cases, seminoma (13 cases) CT showed ipsilateral testis slightly low density of uniform or uneven density mass, mild to moderate persistent, scattered a little necrosis; lymphoma (4 cases) showed a clear boundary Of the round testicular mass, uniform density, was moderately enhanced; the other two cases of alveolar rhabdomyosarcoma, teratoma in 1 case, epidermoid cyst in 1 case, endodermal sinus tumor in 2 cases, embryonal carcinoma in 1 case , Neuroendocrine carcinoma in 1 case. Conclusion CT manifestations of testicular infectious lesions (purulent inflammation, tuberculosis) and neoplastic lesions have certain characteristics. Combined with clinical manifestations such as onset time, age, serum tumor markers and other help to correct diagnosis and identification.