Diagnostic ultrasound ( PDFDrive )

CHAPTER 22 The Scrotum 835
A
B
C
D
E
F
FIG. 22.17 Scrotal Fluid Collections: Spectrum of Appearances. (A) Hydrocele. Transverse scan shows a large hydrocele anterolaterally
with testis partially enveloped by tunica vaginalis posteriorly. (B) Encysted hydrocele. Longitudinal scan along the spermatic cord shows a luid
collection present in the inguinal canal. (C) Encysted hydrocele. Coronal CT image of patient in B demonstrates a well circumscribed luid collection
(arrow) corresponding to sonographic examination. (D) Patent processus vaginalis. Longitudinal scan of inguinal region shows an elongated luid
collection (arrows) above the level of the testis and epididymis (E) in patient with chronic hydrocele. (E) Hematocele. Transverse scan shows loculated
luid with internal echoes and mass affect on the testis (T). (F) Pyocele. Longitudinal scan shows an irregular, centrally hypodense, extratesticular
(T, testis) collection (arrow) adjacent to the epididymis (E) in the setting of epididymo-orchitis.
large hydrocele hampers palpation. Hydroceles are characteristically
anechoic collections with good sound transmission surrounding
the anterolateral aspects of the testis. Low-level to
medium-level echoes from ibrin bodies or cholesterol crystals
may occasionally be visualized moving freely within a
hydrocele. 124 Rarely, a large hydrocele may impede testicular
venous drainage and cause absence of antegrade arterial diastolic
low. 122 Uncommonly, a hydrocele may be loculated
around the spermatic cord above the testis and epididymis,
representing a noncommunicating, encysted hydrocele; or the