Diagnostic ultrasound ( PDFDrive )

CHAPTER
22
The Scrotum
Daniel Sommers and Thomas Winter
SUMMARY OF KEY POINTS
• Diagnostic ultrasound is an accurate means of evaluating
most scrotal processes and can supplement the physical
examination.
• Solid intratesticular lesions have a high likelihood of
malignancy, whereas cystic extratesticular intrascrotal
lesions are almost certainly benign.
• Doppler sonography is the most useful and most rapid
technique to assess the patient with acute scrotal pain.
Ultrasound can establish the diagnosis of testicular
ischemia and help distinguish torsion from other causes of
acute pain such as epididymitis and epididymo-orchitis.
• In the setting of acute scrotal trauma, sonography has a
primary role to evaluate the continuity of the tunica
albuginea and assess for testicular rupture, which requires
early surgical intervention.
• Varicocele is the most common correctable cause of male
infertility and is diagnosed by ultrasound by visualization of
dilatation of the veins (>2-3 mm and increasing in size with
Valsalva maneuver or standing) of the pampiniform plexus
located posterior to the testis.
CHAPTER OUTLINE
SONOGRAPHIC TECHNIQUE
NORMAL ANATOMY
INTRATESTICULAR SCROTAL
MASSES
Malignant Tumors
Germ Cell Tumors
Non–Germ Cell Tumors
Testicular Metastases
Lymphoma and Leukemia
Extramedullary Myeloma
Metastatic Disease
Benign Intratesticular Lesions
Cysts
Tubular Ectasia of Rete Testis
Cystic Dysplasia
Epidermoid Cysts
Abscess
Segmental Infarction
Adrenal Rests
Splenogonadal Fusion
Calciications
EXTRATESTICULAR PATHOLOGIC
LESIONS
Tunica Vaginalis
Hydrocele, Hematocele, and Pyocele
Paratesticular Masses
Hernia
Calculi
Varicocele
Fibrous Pseudotumor
Polyorchidism
Epididymal Lesions
Cystic Lesions
Tumors
Sperm Granuloma
Postvasectomy Changes in the
Epididymis
Chronic Epididymitis
Sarcoidosis
ACUTE SCROTAL PAIN
Torsion
Epididymitis and Epididymo-orchitis
Fournier Gangrene
TRAUMA
CRYPTORCHIDISM
Diagnostic ultrasound is the most common imaging technique
used to supplement the physical examination of the scrotum
and is an accurate means of evaluating many scrotal processes.
Technical advancements in high-resolution real-time sonography
and the ability of color and power Doppler sonography to evaluate
testicular perfusion have improved and expanded the clinical
applications of scrotal sonography to include (among other
indications) assessment of scrotal masses, evaluation of acute
scrotal pain, evaluation of scrotal trauma, assessment of varicoceles
in the infertility workup, assessment for tumors and metastatic
disease, and evaluation of an undescended testis.
SONOGRAPHIC TECHNIQUE
Scrotal ultrasound examination is performed with the patient
in the supine position. he scrotum is elevated on top of a towel
draped over the thighs, and the penis is placed on the patient’s
abdomen and covered with a towel. Optimal results are typically
obtained with a high-frequency (14-18 MHz) linear array
transducer. If greater penetration is needed because of scrotal
swelling, a lower-frequency transducer may be used. A directcontact
scan is performed using acoustic coupling gel. Images
of both testes are obtained in transverse and sagittal planes. he
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