Published online before print February 28, 2003, 10.1148/radiol.2271001744
(Radiology 2003;227:18.)
A more recent version of this article appeared on April 1, 2003
Sonography of the Scrotum1
Vikram S. Dogra, MD,
Ronald H. Gottlieb, MD,
Mayumi Oka, MD and
Deborah J. Rubens, MD
1 From the Department of Radiology, University Hospitals of Cleveland, Case Western Reserve University, 11100 Euclid Ave, Cleveland, OH 44106 (V.S.D.); and Department of Radiology, University of Rochester Medical Center, Rochester, NY (R.H.G., M.O., D.J.R.). Received November 1, 2000; revision requested December 22; final revision received February 13, 2002; accepted March 14. Address correspondence to V.S.D. (e-mail: dogra@uhrad.com).
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Figure 1. Diagrammatic transverse representation of the anatomy of the testis illustrates the relationships of tunica albuginea to mediastinum testis and of mediastinum testis to rete testis. The tunica vaginalis shown here is exaggerated for illustrative purposes; actually, it is a potential space.
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Figure 2a. (a) Longitudinal US scan of a normal testis in a 26-year-old man shows the appendix testis (arrow) as a hypoechoic structure. The presence of hydrocele renders the appendix testis visible. (b) Longitudinal US scan of a normal epididymis in a 24-year-old man shows normal epididymis (arrow).
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Figure 2b. (a) Longitudinal US scan of a normal testis in a 26-year-old man shows the appendix testis (arrow) as a hypoechoic structure. The presence of hydrocele renders the appendix testis visible. (b) Longitudinal US scan of a normal epididymis in a 24-year-old man shows normal epididymis (arrow).
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Figure 3. Transverse US scan of the testis shows a normal transmediastinal artery (arrow) as a linear hypoechoic band. Color Doppler flow US (not shown) revealed flow through the vessel.
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Figure 4. Normal testis in a 24-year-old man. Mediastinum testis (arrow) is a normal finding, seen as an echogenic band running across the testis on a sagittal US scan.
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Figure 5. Surgically proved Fournier gangrene in a 38-year-old man. Longitudinal US scan of the testis (arrowhead) shows sparing of the testis in Fournier gangrene. Both sonograms show scrotal wall thickening (open arrows) and air (long arrow) parallel to the transducer face, with reverberation artifacts (short solid arrows).
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Figure 6a. Surgically confirmed secondary left varicocele in a 60-year-old man. (a) Contrast material-enhanced transverse CT scan and (b) transverse US scan of the left testis (t) reveal large left renal cell carcinoma invading the left renal vein (arrow in a), resulting in secondary varicocele (arrow in b). (Image courtesy of Patrick Fultz, MD, Rochester, NY.)
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Figure 6b. Surgically confirmed secondary left varicocele in a 60-year-old man. (a) Contrast material-enhanced transverse CT scan and (b) transverse US scan of the left testis (t) reveal large left renal cell carcinoma invading the left renal vein (arrow in a), resulting in secondary varicocele (arrow in b). (Image courtesy of Patrick Fultz, MD, Rochester, NY.)
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Figure 7. Clinically proved acute epididymo-orchitis in a 32-year-old man. Transverse US scan of testis shows acute epididymo-orchitis as focal areas of decreased echogenicity (arrowhead) in testicular parenchyma (T), resembling a metastatic lesion with reactive hydrocele (F). These hypoechoic areas were completely resolved at follow-up US after 2 weeks of antibiotic treatment.
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Figure 8. Clinically proved acute epididymitis in a 21-year-old man. Left: Transverse US scan of right testis and epididymis shows an enlarged hypoechoic epididymis (arrow). Right: Transverse color Doppler US scan of same epididymis demonstrates increased vascularity (arrow). The testis is normal.
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Figure 9. Surgically proved adenomatoid tumor in the left hemiscrotum of a 42-year-old man. Transverse US scan of left testis shows a heterogeneous extratesticular mass (arrow) measuring 2.75 x 2.49 cm in the inferomedial portion of the testis. At surgery, the tumor was found to arise from the tail of the epididymis.
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Figure 10. Surgically proved testicular torsion in a 20-year-old man. Longitudinal color Doppler US scan shows an enlarged hypoechoic testis (arrow) with no intratesticular blood flow. Increased paratesticular flow (arrowhead) is secondary to hyperemia.
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Figure 11. Bilateral undescended testes in a 36-year-old man. Longitudinal US scan of the right testis at the level of the inguinal canal reveals an oval-shaped testis, which is hypoechoic relative to surrounding structures (arrow). Left testis is not shown.
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Figure 12. Surgically proved germ cell tumor in a 34-year-old man. Sagittal US scan of left testis shows multiple microliths (straight arrow) and a hypoechoic focal lesion (curved arrow, cursors), which was determined to be a germ cell tumor.
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Figure 13. Scrotoliths (scrotal pearls) in a 30-year-old man. Transverse US scan of testes shows extratesticular echogenic foci (arrow) with posterior acoustic shadowing. There is minimal fluid in the tunica vaginalis (arrowhead).
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Figure 14. Surgically proved intratesticular epidermoid cyst in a 21-year-old man. Longitudinal US scan of left testis reveals a well-circumscribed hypoechoic mass with a concentric lamellar pattern (curved arrow) of alternating hyper- and hypoechoic rings. This US appearance is referred to as the onion-ring appearance and is characteristic of epidermoid cyst. (Reprinted, with permission, from reference 115.)
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Figure 15. Tubular ectasia in a 60-year-old man. Longitudinal US scan of the testis reveals multiple channels (arrow) on the posterolateral aspect of the testis. Color Doppler US (not shown) did not demonstrate any flow.
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Figure 16a. Intratesticular varicocele in a 38-year-old man. (a) Transverse oblique US scan of left testis reveals multiple intratesticular anechoic cystic areas (arrowhead). (b) Duplex Doppler US scan shows that venous flow in these cystic areas increases during a Valsalva maneuver (arrowhead).
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Figure 16b. Intratesticular varicocele in a 38-year-old man. (a) Transverse oblique US scan of left testis reveals multiple intratesticular anechoic cystic areas (arrowhead). (b) Duplex Doppler US scan shows that venous flow in these cystic areas increases during a Valsalva maneuver (arrowhead).
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Figure 17a. Surgically proved seminoma in a 35-year-old man. (a) Longitudinal US scan of testis reveals a well-circumscribed heterogeneous intratesticular mass. A rim of normal testicular parenchyma (arrow) surrounds the mass. (b) Color Doppler flow US scan reveals increased tumor vascularity (arrow).
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Figure 17b. Surgically proved seminoma in a 35-year-old man. (a) Longitudinal US scan of testis reveals a well-circumscribed heterogeneous intratesticular mass. A rim of normal testicular parenchyma (arrow) surrounds the mass. (b) Color Doppler flow US scan reveals increased tumor vascularity (arrow).
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Figure 18. Surgically proved seminoma in a 35-year-old man. Transverse oblique US scan of testis shows seminoma manifesting as cystic areas (arrowhead) with fluid-debris levels (arrow).
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Figure 19. Surgically proved testicular immature teratoma manifesting as a cystic mass in a 23-year-old man. Transverse US scan of right testis reveals multiple cystic areas (arrow) measuring 2-15 mm. Cystic areas involved nearly the entire testis, leaving only a rim of normal testicular parenchyma (arrowhead). These cystic changes can be easily differentiated from tubular ectasia, which is confined to the mediastinum and occurs in older men. (Reprinted, with permission, from reference 115.)
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Figure 20a. Surgically proved rupture of tunica albuginea in a 34-year-old man who was struck in the groin. (a) Transverse oblique US scan of testis reveals a heterogeneous mass (arrow) in the inferior pole. (b) Color Doppler flow US scan reveals focal absence of blood flow in the tunica vasculosa (arrow), suggestive of tunica albuginea fracture. There was associated hematoma of the epididymis as well.
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Figure 20b. Surgically proved rupture of tunica albuginea in a 34-year-old man who was struck in the groin. (a) Transverse oblique US scan of testis reveals a heterogeneous mass (arrow) in the inferior pole. (b) Color Doppler flow US scan reveals focal absence of blood flow in the tunica vasculosa (arrow), suggestive of tunica albuginea fracture. There was associated hematoma of the epididymis as well.
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Copyright © 2003 by the Radiological Society of North America.
