Diagnostic ultrasound ( PDFDrive )

CHAPTER 22 The Scrotum 843
A
B
FIG. 22.26 Postvasectomy Changes. (A) Sperm granuloma. Transverse scan shows a heterogeneous mass (arrow) along the vas deferens
and separate from the epididymis (E) in a postvasectomy patient. (B) Postvasectomy changes in epididymis. Longitudinal image of the scrotum
shows ectasia of the ductules of the epididymis (arrows) in a patient who had a vasectomy. See also Videos 22.4 and 22.5.
A
B
FIG. 22.27 Tuberculous Epididymo-orchitis. (A) Longitudinal scan shows a heterogeneous mass with calciication involving the head and
body of the epididymis and the adjacent testis (T). (B) Longitudinal color Doppler image shows increased vascularity in the epididymis and adjacent
testis.
rate from torsion but also an increase in unnecessary surgical
procedures. Real-time sonography, Doppler sonography, testicular
radionuclide scintigraphy, and MRI have been used to increase
the accuracy of distinguishing between infection and torsion. 158
Currently, sonography using color low or power Doppler is
the imaging study of choice to diagnose the cause of acute
scrotal pain.
FIG. 22.28 Testicular Sarcoid. Longitudinal scan of the testis shows
multiple, small, hypoechoic, solid masses resulting from sarcoid.
routine physical examination or laboratory tests in up to 50% of
patients. 157 In the past, immediate surgical exploration was been
advised in boys and young men with acute scrotal pain, unless
a deinitive diagnosis of epididymitis or orchitis was made. his
aggressive approach resulted in an increased testicular salvage
Causes of Acute Scrotal Pain
Torsion of the testis
Epididymo-orchitis
Testicular or epididymal appendage torsion
Strangulated hernia
Trauma
Idiopathic scrotal edema
Henoch-Schönlein purpura