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U/S Imaging of scrotal diseases
Dr.Henock , Radiology Resident
Ayder Hospital
Indications
 Acute scrotum
 Trauma
 Palpable mass
 Infertility or chronic pain
Acute scrotum
 Infection
 Torsion
N.B color Doppler
Infection
 Epididymitis
- bladder or prostate
- tail
 Epididymo-orchitis
- 20- 40 %
Cont..
 U/S findings of Epididymo-orchitis
 Enlarged
 Hypo/ heteroechoic
 Indirect signs of inflammation : Hydrocele , scrotal wall thickening ,
pyocele
Cont..
 CDFI and PD
 100% sensitivity
 Hyperemia
 High flow , low resistance pattern
Cont..
Cont..
 Complications
 Isolated orchitis
Torsion
 Intra vaginal
 Extra vaginal
Adolescents
-Bell-clapper deformity
 - Typically bilateral
Cont..
Cont..
- Clinically
- phases
 U/S features
 Vary with duration and degree of rotation
 Grey Scale  Nonspecific (Normal if hyper acute)
 < 6 hours : Testicular swelling and hypo echogenicity
 >24hrs: Heterogeneous due to congestion , hemorrhage and
infarction
Cont..
 imaging of scrotal diseases
Cont..
Cont..
 CDFI
 Does not exclude torsion
 Absence of identifiable intra-testicular flow
o Sensitivity 86%
o Specific 100%
o Accuracy 97%
Cont..
 SALVAGE RATE
 <6 hours  100%
 6-12 hrs  70%
 12-24 hrs - 20%
Testicular infarct
Cont..
 Torsion of appendix testis ; Blue dot sign :
 imaging of scrotal diseases
Cont..
 Trauma
Cont..
 Testicular rupture
Cont
 Traumatic infarction
Palpable or non palpable masses
 Testicular vs extratesticular
 Cystic vs solid
Intra-testicular
 solid
-neoplasm - sarcoid
-adrenal rest
 cystic
- intratesticular cyst
- epidermoid cyst
- cystic teratoma
- duct ectasia of rete testis
 ca ++
- burnout GCT
- granulomatous
- testicular microlitiasis
 Germ cell tumor: 95% of malignant testicular T
Seminoma; 50%
Non-Seminoma: Embryonal carcinoma
Yolk sac tumor
Choriocarcinoma
Teratoma
 Stromal tumor:
Leyding cell T- Sertoli cell T
Granulosa cell T  Fibroma- Thecoma
 Mesenchymal tumor:
Leiomyoma- Neurofibroma
Adenomatoid tumour
Hemangioma- Sarcoma
 Lymphoid and Hematopoietic Tumors:
Lymphoma-Leukemia
 Metastasis [ prostate- bronchus- m. melanoma- colon]
Testicular lesions
Malignant tumor
Seminoma
Non seminoma
Lymphoma
Cont..
 Adrenal rests
Cystic
 Cystic teratoma
 Intra-testicular cyst
 Adjacent to mediastinum testis
Cont
 Epidermoid cyst
-20 -40 yrs
- Asymptomatic
- onion ring
- Avascular
Cont..
 Tubular ectasia of rete testis
 >50 yrs
 Adjacent to mediastinum testis
Calcifications
 Burned out tumor
- Rapid growth
- Blood supply occlusion
 Testicular microlitiasis
- 1-3mm
- no shadowing
- 21 x increased risk
Epididymis
 Solid
- adenomatoid tumour
- leomyoma
- sperm granuloma
- granulomatous disease
 cystic
- spermatocele
- epididymal cyst
 ca++
- TB epidydymitis
Solid
 Adenomatoid tumour
- commenest
- round, iso ,homogenous
- tail
 Sperm cell granuloma
- extravasation
Cont..
 Granulomatous
 TB epididymitis ; enlarged heterogeneous -tail
Cont..
 Sarcoid
- Enlarged with hypoechoic nodules
Cystic
 Spermatocele
 Epididymal cyst
 Asymptomatic
 Dilatation of epididymal tubules
Cont
 Tunica albuginea cyst
Scrotal cavity
 Solid
- scrotal hernia
- spermatic cord neoplasm
 cystic
-hydrocele
- pyocele
- hematocele
 ca ++
- scrotal pearl
Solid
 Scrotal hernia
Cont..
 Hydrocele
 Pyocele , hematocele; internal echoes
Cont..
 Fournier's gangrene
Cont..
 Idiopathic scrotal edema
Male infertility
 In men with impaired fertility ,ultrasound can provide
diagnostic information
cont...
 Varicocele
 >2mm
 Primary or secondary
 Left
 Intra vs extra testicular
 imaging of scrotal diseases
Newer Ultrasound Technology to
Assess Fertility
 RI and PSV
 Azospermia
Cont
 Sono elastography
 Intraoperative testicular u/s
- for testis sparing surgery
References
 Ultrasound of the Male Genitalia, Bruce R. Gilbert, MD, PhD
 Diagnostic imaging Genitourinary ,3 rd edition
 Diagnostic medical sonography, abdomen and superficial
structures
 Carol diagnostic u/s
Thank you !

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