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ULTRASOUND OF SCROTUM
BY DR LOHITH VARMA
1ST YEAR PG
DUCTUS DEFERENS
TESTIS
•
•
•
SPECTRAL DOPPLER: THE TESTIS DEMONSTRATES A LOW-RESISTANCE ARTERIAL WAVEFORM
EPIDIDYMIS
• EPIDIDYMAL HEAD
•
•
• EPIDIDYMAL BODY
•
• EPIDIDYMAL TAIL
DUCTUS DEFERENS
•
• APPENDIX EPIDIDYMIS
•
SPECTRAL DOPPLER: EPIDIDYMIS DEMONSTRATES A LOW-RESISTANCE ARTERIAL WAVEFORM
PROTOCOL FOR ULTRASOUND OF THE SCROTUM
EQUIPMENT SELECTION AND TECHNIQUE
1.
2.
3.
SCANNING TECHNIQUE
1.
2.
3.
4.
5.
6.
7.
8.
9.
A SCROTAL ULTRASOUND SHOULD INCLUDE THE FOLLOWING
MINIMUM IMAGES
•
•
•
•
•
•
•
•
•
•
ACUTE SCROTAL PAIN AND SWELLING
EPIDIDYMITIS AND EPIDIDYMO-ORCHITIS
•
•
• ASSOCIATED FINDINGS :
•
TORSION
BELL CLAPPER DEFORMITY :
TORSION
WHIRLPOOL SIGN
Enlarged heterogeneous left
testicle
Color Doppler evaluation shows flow in the right
but not in the left testicle
• ALTERED BLOOD FLOW
INCOMPLETE TORSION
•
•
COMPLETE TORSION
•
• SALVAGE OF THE TESTIS IS DIRECTLY RELATED TO THE TIME BETWEEN ONSET AND
DETORSION (WHETHER IT BE SURGICAL OR SPONTANEOUS) :
<6 HOURS: ~100% SALVAGE
6-12 HOURS: 50%
12-24 HOURS: 20%
TRAUMA
•
•
TESTICULAR TRAUMA.
PALPABLE LUMPS AND
INCIDENTAL FINDINGS
EPIDIDYMAL CYST
TESTICULAR CYST
•
•
•
EPIDERMOID CYST
•
•
•
•
•
•
Complex solid and cystic-appearing lesion in the testicle
does not demonstrate internal vascularity
SPERMATOCELE
•
•
•
•
• VARICOCELES FORM DUE TO IMPAIRED DRAINAGE OF BLOOD
FROM THE SPERMATIC CORD CAUSING ABNORMAL
DILATATION OF THE PAMPINIFORM PLEXUS
• MULTIPLE HYPO- OR ANECHOIC TUBULAR STRUCTURES
GREATER THAN 2 TO 3 MM IN DIAMETER.
• DURING THE VALSALVA MANEUVER THE VARICOCELE MAY
ENLARGE AND IT MAY DEMONSTRATE FLOW REVERSAL ON
COLOR DOPPLER IMAGING DEPENDING ON GRADE
• VARICOCELES ARE MOST COMMONLY FOUND ON THE LEFT
SIDE
GRADING OF VARICOCELE
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
HYDROCELE
GERM CELL TUMORS
• SEMINOMA
• NON- SEMINOMATOUS GERM CELL TUMORS (NSGCTS)
SEMINOMA
NON- SEMINOMATOUS GERM CELL TUMORS
THANQ

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ULTRASOUND SCROTUM