Diagnostic ultrasound ( PDFDrive )

CHAPTER 54 Pediatric Pelvic Sonography 1903
A B C POST VAL
FIG. 54.50 Left Varicocele in Postpubertal Patient Complaining of Feeling “Wormlike” Structures in Left Side of Scrotum. (A) Transverse
color Doppler sonogram of the left testis shows multiple areas illed with color in the paratesticular tissues lateral to the normal-appearing left
testis. (B) Sagittal scan of the paratesticular tissues demonstrates prominent, anechoic, tortuous, tubular structures. (C) Exuberant color Doppler
low and enlargement of these paratesticular veins is seen after Valsalva maneuver.
Epi Head
A
FIG. 54.51 Epididymal Cysts. Teenage boy with left-sided scrotal masses. (A) Sagittal scan demonstrates a small cyst (arrow) in the head of
the epididymis and a normal left testis. (B) Transverse scan of the inferior aspect of the left testis demonstrates a larger cyst (arrow) in the adjacent
tail of the epididymis. A small hydrocele is present.
B
Epi Tail
LT Testicle SAG
walls, which may contain debris (Fig. 54.51). hey range in size
from a few millimeters to several centimeters. 182 Other cystic
lesions include spermatic cord cysts and cysts of the tunica
vaginalis.
Paratesticular Tumors
Both benign and malignant paratesticular tumors are rare and
typically involve the epididymis or spermatic cord. hey may
also arise in the appendix testis or the tunica. About 30% of
spermatic cord tumors are malignant and in general are caused
by embryonal rhabdomyosarcoma 156,186 (Fig. 54.52). his tumor
usually appears as a rapidly growing, painless, intrascrotal mass
in boys younger than 5 years. Up to 40% have retroperitoneal
lymph node involvement at diagnosis. 186 Other malignant lesions
include metastatic neuroblastoma, lymphoma, leiomyosarcoma,
and ibrosarcoma. 175,187,188 hey are usually well-deined, homogeneous
or heterogeneous, hypoechoic solid masses. Benign
paratesticular tumors include ibromas, hemangiomas, lipomas,
leiomyomas, lymphangiomas, and neuroibromas. Both benign
and malignant paratesticular tumors may appear hypoechoic,
Mass
FIG. 54.52 Paratesticular Rhabdomyosarcoma. Large, solid mass
was identiied medial to left testis (T) with a small hydrocele in this
18-month-old boy.
T