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.

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 !