Diagnostic ultrasound ( PDFDrive )

CHAPTER 22 The Scrotum 837
A
B
C
D
FIG. 22.19 Benign Intrascrotal Calciication. (A) Calciied tunica plaque (arrow) on the tunica vaginalis. (B)-(D) Scrotal pearls. (B) Mobile
scrotal calciication in a small hydrocele. (C) Longitudinal scan shows a mostly calciied scrotal pearl (arrow) in a hydrocele. T, Testis. (D) Bilateral
scrotal pearls.
from the tunica vaginalis, or from torsion of the appendix testis
or appendix epididymis. Sonographically, they appear as free
loating, echogenic calculi with posterior acoustic shadowing;
can be multiple; and range in size from a few millimeters to
larger than a centimeter. Hydroceles facilitate the sonographic
diagnosis of scrotal calculi.
Varicocele
A varicocele is an abnormal dilatation of the veins of the pampiniform
plexus located posterior to the testis, adjacent to the
epididymis, and accompanying the vas deferens within the
spermatic cord 14 (Fig. 22.20). A varicocele is the most frequently
encountered mass of the spermatic cord. he veins of the
pampiniform plexus normally range from 0.5 to 1.5 mm in
diameter, with a main draining vein up to 2 mm in diameter.
he size for normal varies, with some diagnosticians using greater
than 2 mm as a guideline for the diagnosis of a varicocele and
others using 3 mm. 131
here are two types of varicoceles: primary (idiopathic) and
secondary. he idiopathic varicocele is caused by incompetent
valves in the internal spermatic vein, which results in impaired
drainage of blood from the spermatic vein and pampiniform
plexus with the patient in an upright position. Varicoceles afect
approximately 15% of men but occur in up to 40% of men
attending infertility clinics. 132,133 Varicocele is the most common
correctable cause of male infertility. 134 Idiopathic varicoceles
occur much more commonly on the let side and are most
common in men aged 15 to 25 years. he let-sided predominance
probably occurs because the let testicular vein is longer, with
venous drainage into the let renal vein entering the renal vein