Diagnostic ultrasound ( PDFDrive )

CHAPTER 22 The Scrotum 839
A
B
C
FIG. 22.21 Varicocele Caused by Retroperitoneal
Paraganglioneuroma. (A) Longitudinal scan shows extremely
dilated veins of large, right varicocele. (B) Transverse abdominal
sonogram shows paraganglioneuroma (arrow) adjacent to the
inferior vena cava (I). A, Aorta; GB, gallbladder. (C) Axial CT
scan shows the vascular mass (arrows) adjacent to inferior
vena cava.
FIG. 22.22 Intratesticular Varicocele. Longitudinal scan shows the
dilated intratesticular veins.
mass (Fig. 22.24). Twenty percent of supernumery testes are
inguinal with the remaining retroperitoneal in location. 60 hese
supernumery testes have similar imaging characteristics to normal
testes, but they are more mobile and therefore at increased risk
of torsion. here has also been an increased risk of carcinoma
reported. 131,135,137,143
Epididymal Lesions
Cystic Lesions
he most common epididymal mass is a cyst, which includes
epididymal cysts and spermatoceles. Both were seen in 20%
to 40% of all asymptomatic patients studied by Leung et al., 144
and were multiple in 30% of cases. Both epididymal cysts and
spermatoceles are thought to result from dilatation of the
epididymal ductules, but the contents of these masses difer. 14
Epididymal cysts contain clear serous luid, whereas spermatoceles
are illed with spermatozoa and sediment containing
lymphocytes, fat globules, and cellular debris, giving the
luid a thick, milky appearance. 3 Both lesions may result from
prior episodes of epididymitis or trauma. Spermatoceles and
epididymal cysts appear identical on sonography: anechoic,
circumscribed masses with no or few internal echoes. Loculations
and septations are oten seen (Fig. 22.25). In rare cases,
a spermatocele may be hyperechoic. 9 Diferentiation between
a spermatocele and an epididymal cyst is rarely important
clinically. Spermatoceles almost always occur in the head of the
epididymis and represent cystic dilatation of eferent ductules,
whereas epididymal cysts arise throughout the length of the
epididymis.