imaging of scrotal diseases

Jul 30, 2019Download as PPTX, PDF3 likes214 views

This document provides an overview of ultrasound imaging indications and findings for scrotal diseases. It discusses acute scrotum conditions like infection and torsion, palpable masses that can be intra- or extra-testicular, and infertility evaluations. Key points covered include Doppler ultrasound features of epididymo-orchitis, stages of testicular torsion, characteristics of seminoma and non-seminoma tumors, varicocele assessment, and emerging technologies like elastography.

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..
• Complications
• Isolated orchitis

Torsion
• Intra vaginal
• Extra vaginal
•Adolescents
•-“Bell-clapper” deformity
• -‒ Typically bilateral

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..
 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%

Cont..
• Torsion of appendix testis ; Blue dot sign :

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

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

Scrotal cavity
 Solid
- scrotal hernia
- spermatic cord neoplasm
 cystic
-hydrocele
- pyocele
- hematocele
 ca ++
- scrotal pearl

Cont..
• Hydrocele
• Pyocele , hematocele; internal echoes

Male infertility
• In men with impaired fertility ,ultrasound can provide
diagnostic information

cont...
• Varicocele
 >2mm
 Primary or secondary
 Left
 Intra vs extra testicular

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

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imaging of scrotal diseases

1. U/S Imaging of scrotal diseases Dr.Henock , Radiology Resident Ayder Hospital

2. Indications • Acute scrotum • Trauma • Palpable mass • Infertility or chronic pain

3. Acute scrotum  Infection  Torsion N.B color Doppler

4. Infection • Epididymitis - bladder or prostate - tail • Epididymo-orchitis - 20- 40 %

5. Cont..  U/S findings of Epididymo-orchitis  Enlarged  Hypo/ heteroechoic  Indirect signs of inflammation : Hydrocele , scrotal wall thickening , pyocele

6. Cont..  CDFI and PD  100% sensitivity  Hyperemia  High flow , low resistance pattern

7. Cont..

8. Cont.. • Complications • Isolated orchitis

9. Torsion • Intra vaginal • Extra vaginal •Adolescents •-“Bell-clapper” deformity • -‒ Typically bilateral

10. Cont..

11. 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

12. Cont..

14. Cont..

15. Cont..  CDFI  Does not exclude torsion  Absence of identifiable intra-testicular flow o Sensitivity 86% o Specific 100% o Accuracy 97%

16. Cont..  SALVAGE RATE • <6 hours – 100% • 6-12 hrs – 70% • 12-24 hrs - 20%

17. Testicular infarct

18. Cont.. • Torsion of appendix testis ; Blue dot sign :

20. Cont.. • Trauma

21. Cont.. • Testicular rupture

22. Cont… • Traumatic infarction

23. Palpable or non –palpable masses • Testicular vs extratesticular • Cystic vs solid

24. 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

25.  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

26. Seminoma

27. Non seminoma

28. Lymphoma

29. Cont.. • Adrenal rests

30. Cystic • Cystic teratoma • Intra-testicular cyst  Adjacent to mediastinum testis

31. Cont… • Epidermoid cyst -20 -40 yrs - Asymptomatic - onion ring - Avascular

32. Cont.. • Tubular ectasia of rete testis  >50 yrs  Adjacent to mediastinum testis

33. Calcifications  Burned –out tumor - Rapid growth - Blood supply occlusion  Testicular microlitiasis - 1-3mm - no shadowing - 21 x increased risk

34. Epididymis  Solid - adenomatoid tumour - leomyoma - sperm granuloma - granulomatous disease  cystic - spermatocele - epididymal cyst  ca++ - TB epidydymitis

35. Solid  Adenomatoid tumour - commenest - round, iso ,homogenous - tail  Sperm cell granuloma - extravasation

36. Cont.. • Granulomatous  TB epididymitis ; enlarged heterogeneous -tail

37. Cont.. • Sarcoid - Enlarged with hypoechoic nodules

38. Cystic • Spermatocele • Epididymal cyst  Asymptomatic  Dilatation of epididymal tubules

39. Cont • Tunica albuginea cyst

40. Scrotal cavity  Solid - scrotal hernia - spermatic cord neoplasm  cystic -hydrocele - pyocele - hematocele  ca ++ - scrotal pearl

41. Solid • Scrotal hernia

42. Cont.. • Hydrocele • Pyocele , hematocele; internal echoes

43. Cont.. • Fournier's gangrene

44. Cont.. • Idiopathic scrotal edema

45. Male infertility • In men with impaired fertility ,ultrasound can provide diagnostic information

46. cont... • Varicocele  >2mm  Primary or secondary  Left  Intra vs extra testicular

48. Newer Ultrasound Technology to Assess Fertility • RI and PSV • Azospermia

49. Cont… • Sono elastography • Intraoperative testicular u/s - for testis sparing surgery

50. 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

51. Thank you !

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imaging of scrotal diseases

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