This document summarizes various pathologies that can be identified on scrotal ultrasound. It describes common extratesticular masses like hydrocele, varicocele, and spermatocele. Hydrocele appears as an anechoic collection without flow in the tunica vaginalis. Varicocele involves dilated veins around the testicle visible with color Doppler. Spermatoceles are benign cysts filled with sperm that appear hypoechoic. It also discusses testicular torsion, epididymitis, trauma, cysts, teratomas, seminomas, lymphomas, and microlithiasis.

1. SCROTAL USG
Dr F Ahmad

2. Extratesticular scrotal masses
• The most common extratesticular masses
are hydrocele
• Varicocele
• Spermatocele.

3. Hydrocele
• Hydrocele is fluid accumulation in the tunica vaginalis
covering the testicles.
• Ultrasound characteristics:
• anechogenic collection in the tunica vaginalis
• the collection shows NO color Doppler flow

4. In the sagittal plane. Hydrocele.

5. Causes:
• Idiopathic.
• Congenital
•
• Imbalance of fluid production in the tunica
vaginalis, e.g. due to reduced lymphatic
drainage, infection or tumor

6. Varicocele
• In varicocele, peritesticular veins are dilated (‘varicose veins’)
due to reduced function of the spermatic vein. Varicocele
generally develops in the left side of the scrotum.
Particularly when standing and with increased pressure
(coughing/straining) a 'sausage-like’ swelling can be felt.
Varicocele is generally asymptomatic, but can sometimes
produce pain on exertion.
• Ultrasound characteristics (fig. 15/16):
• multiple tortuous dilated veins (lateral, posterior or superior
of the testicle).
• increased venous flow in the Valsava maneuver
(straining/coughing).

7. ♦ Figure.ColorDoppleroflefttesticleinthesagittalplane.Posteriorof thetesticle
isadilatedtortuousperitesticularvein.Pictureconsistentwithvaricocele.

8. ♦Figure16.ColourDoppleroflefttesticleinthetransversalplane.

9. Spermatocele
• Spermatoceles are the most common scrotal masses. They are
bony cystic structures filled with (dead) sperm cells. They are
located in the epididymal head. Spermatocele cannot be
accurately distinguished by ultrasound from an epididymal
cyst.
Spermatoceles are rarely symptomatic.
Ultrasound characteristics (fig. 17/18):
• sharply delineated hypoechogenic lesions.
• may contain echogenic debris (= sperm cells).

10. ♦ largespermatocele/epididymalcyst.

11. ♦ Asmallspermatocele/epididymalcyst.

12. Testiculartorsion
• The testicles may become twisted around the funiculus
spermaticus (= spermatic cord).
• As a result, testicular circulation will be compromised; starting
with venous obstruction followed by arterial obstruction. The
testicles will eventually die off.
• For this reason, it is important to detorse the testicles
(surgically where necessary) within +-6 hours after the start of
symptoms .

14. Classical:
• age: puberty – 25 years.
• acute severe pain.
• painful (bluish) swollen half of the scrotum.

15. •The most sensitive finding of ischemia
is reduced/absent colour Doppler
signal. The colour Doppler signal of
the other (non-painful) testicle is used
as reference

18. SCROTAL USG
Dr F Ahmad

19. Diagnosis
• Epididymitis
• Trauma
• Types of Cyst
• Teratoma
• Seminomas
• Lymphomas
• Microlithiasis

20. Epididymitis
• In the differential diagnosis of acute pain and swelling of the
scrotum, scrotal inflammation is the most common disorder in
addition to testicular torsion.
A scrotal infection usually involves the epididymis and then
spreads to the testicles and scrotal wall. The infection may
affect the entire epididymis or only a focal area.
Patients are usually treated with antibiotics.
Ultrasound characteristics of epididymitis
• enlarged epididymis.
• Increased echogenicity of the epididymis.
• Chronic epididymitis may have both hypo and hyperechogenic
areas .
• increased colour doppler signal (vascularization!).
• Comment: vascularization may be the only ultrasound
abnormality in epididymitis.

21. 1

22. 1a Rt testis

23. 2

24. Rt

25. Lt

26. 3

27. • After injury testis my be enlarged or remain normal in
size .
• When there is excess fluid in the scrotum , the testis
should be scanned at many different angles to exclude
rupture .
• The injured testis may show complex echogenicity
,especially when there is an internal haematoma or
subsequent abscess .
• Blood will appear as fluid within the scrotum often with
complex echogenicity due to blood clots

32. • A teratoma is a rare type of tumour that can contain different
types of tissue ,such as hair , muscle, teeth or bone.
• Teratoma of the Testis is a type of testicular cancer affecting
the germ cells of sperm. Germ cells are precursors to sperm
cells that will eventually transform into sperms .
•

35. • A seminoma is a germ cell tumor of the testicle
or, more rarely, the mediastinum or other extra-
gonadal locations. It is a malignant neoplasm
and is one of the most treatable and curable
cancers, with a survival rate above 95% if
discovered in early stages. Testicular seminoma
originates in the germinal epithelium of the
seminiferous tubules. About half of germ cell
tumors of the testicles are seminomas.

36. Seminoma

40. • Testicular microlithiasis is an unusual condition
diagnosed on testicular ultrasound. It is found in
between 1.5 to 5% of normal males, and may be
found in up to 20% of individuals with
subfertility. It is an asymptomatic, non-
progressive disease. Testicular microlithiasis is
not associated with risk of testicular cancer in
asymptomatic individuals with no risk factors for
testicular germ cell tumor.