Bildgebende Diagnostik beim akuten Skrotum

Zusammenfassung

Das akute Skrotum gehört zu den häufigsten urologischen Notfällen bei Kindern und Jugendlichen und bezeichnet das plötzliche Auftreten von Schmerzen im Skrotum, meist einhergehend mit begleitender Schwellung und Rötung des betroffenen Hodens. Am wichtigsten ist es zunächst festzustellen, ob ein chirurgisches Vorgehen mit Hodenfreilegung notwendig ist, oder ein konservatives Vorgehen gerechtfertigt ist. Da Anamnese und körperliche Untersuchung nicht immer eindeutig sind, kommt ergänzend oft die Sonografie mit farbkodierter Dopplersonografie als Bildgebung der 1. Wahl zum Einsatz. Hiermit gelingt es meist, eine OP-Pflichtige Hodentorsion oder auch eine Hodenruptur nach Trauma von ihren Differenzialdiagnosen, wie z. B. die Hydatidentorsion oder die Epididymorchitis zu unterscheiden. Weiterführende bildgebende Verfahren wie MRT, Szintigrafie oder kontrastmittelverstärkte Sonografie sind nur bei unklaren Fällen oder Komplikationen im Verlauf indiziert.

Abstract

Acute scrotum is one of the most common urologic emergencies in children and adolescents. This condition involves acute testicular pain, which is often accompanied by scrotal swelling and erythema. It is most important to distinguish between cases that require immediate surgery and those that can be treated conservatively. As patient history and physical findings may not always be unequivocal, ultrasound with Colour-Coded Doppler Sonography is the imaging modality of choice for further evaluation. Testicular torsion and other differential diagnoses such as epididymitis, appendiceal torsion, intratesticular haematoma after trauma, or complicated inguinal hernia have to be considered. Other imaging modalities such as MRI, scintigraphy and contrast-enhanced ultrasound are only necessary if the diagnosis remains unclear or if complications occur during the course of disease.

Schlüsselwörter

akutes Skrotum - Hodentorsion - Epididymitis - Ultraschall - Farbdopplersonografie

Key words

acute scrotum - testicular torsion - epididymitis - ultrasound - Colour-Coded Doppler Sonography

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