Diagnostic ultrasound ( PDFDrive )

834 PART III Small Parts, Carotid Artery, and Peripheral Vessel Sonography
A B C
D E F
G H I
FIG. 22.16 Microlithiasis and Associated Testicular Tumors: Spectrum of Appearances. (A) Light microscopy examination shows multiple
intratubular calciications (dark areas) characteristic of microlithiasis. (B) Longitudinal scan shows a few tiny calciications of limited microlithiasis.
(C) and (D) Diffuse microlithiasis. (E) Transverse scan of testis shows microlithiasis and partially cystic mass caused by mixed germ cell tumor.
(F) Limited microlithiasis with seminoma. Longitudinal scan shows a few tiny calciications and a homogeneous hypoechoic mass. (G) Longitudinal
scan shows microlithiasis and two hypoechoic homogeneous masses (arrows) due to seminoma. (H) Longitudinal scan shows large hypoechoic
mass with multiple small and coarser calciications. (I) Dual transverse image shows large hypoechoic left testicular mass and microcalciications
in the right testis.
associated with a mass, management is dictated by the intratesticular
mass itself. It has been correlated with testicular carcinoma,
although the extent of the risk for subsequent development of
neoplasm and the recommended surveillance in the setting of
microlithiasis remain controversial. 114,115,118 Annual physical
examination and periodic self-examination have been suggested
for those who have no additional risk factors. 114,115,119,120 Recent
literature suggests that there is no causal link and that sonographic
follow-up of microlithiasis should be determined by any additional
risk factors and not the microlithiasis itself. 121
EXTRATESTICULAR PATHOLOGIC
LESIONS
Tunica Vaginalis
Hydrocele, Hematocele, and Pyocele
he normal scrotum contains a few milliliters of serous luid
between the layers of the tunica vaginalis, and this is usually
visible on sonographic examination. Larger volumes of serous
luid, and blood, pus, or urine may also accumulate in the space
between the parietal and visceral layers of the tunica vaginalis
lining the scrotum. hese luid collections should be conined
to the anterolateral portions of the scrotum because of the
attachment of the testis to the epididymis and scrotal wall
posteriorly (the bare area) 9 (Fig. 22.17).
Hydrocele is an abnormal accumulation of serous luid
between the layers of the tunica vaginalis. Hydrocele is the
most common cause of painless scrotal swelling 14 and may be
congenital or acquired. he congenital type results from
incomplete closure of the processus vaginalis, with persistent
open communication between the scrotal sac and the peritoneum,
usually resolving by 18 months of age (Fig. 22.17D).
Acquired hydroceles may be idiopathic or caused by epididymitis,
epididymo-orchitis, torsion, or, in rare cases, tumors.
Hydroceles associated with testicular tumors are usually
small. 3,122,123 Sonography is useful in detecting a potential cause
of the hydrocele by allowing evaluation of the testis when a