Testicular Ultrasound



Figure 13.1
Normal testicle. Longitudinal view of normal testicle using linear probe showing homogenous testicular architecture



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Figure 13.2
Color Doppler. Longitudinal view of normal testicle showing normal blood flow with color Doppler


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Figure 13.3
Appendix testis. Testicular appendix (arrow), which represents a developmental remnant, is typically found on the upper pole of the testis near the epididymal head


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Figure 13.4
Normal epididymis. Normal epididymis (arrow) seen adjacent to the testicle




Testicular Pathology





  1. 1.


    Hydrocele


    1. (a)


      Hydrocele is a collection of fluid between the visceral and parietal layers of the tunica vaginalis.

       

    2. (b)


      Congenital hydrocele is common and occurs due to a direct communication with the peritoneum [1].

       

    3. (c)


      Acquired hydroceles are typically associated with infection, tumor, trauma, torsion, or radiation therapy [1].

       

    4. (d)


      Hydrocele will appear as anechoic fluid surrounding the testicle without layering or septations:



      • Figure 13.5—Hydrocele


      • Video 13.4—Hydrocele


      • Figure 13.6—Hydrocele near testes and epididymis

       

    5. (e)


      A complex hydrocele, such as hematocele or pyocele, will contain internal echoes with septations or loculations.

       

     

  2. 2.


    Varicocele


    1. (a)


      Varicocele is an abnormal enlargement of the pampiniform venous plexus within the spermatic cord [1]:



      • Usually idiopathic which is caused by valvular incompetence of the internal spermatic vein resulting in retrograde flow into the pampiniform plexus [1]:



        • Ninety-nine percent of idiopathic varicoceles occur on the left [1] due to anatomical differences in between the right and left spermatic veins:



          • The right spermatic vein drains directly into the inferior vena cava [1].


          • The left spermatic vein drains into the left renal vein at almost a 90° angle [1].


      • Secondary causes are usually due to compression of the spermatic vein due to various pathology such as a mass, hydronephrosis, or hepatomegaly [1]. Malignancy should also be considered.

       

    2. (b)


      Varicoceles appear as a cluster of hypoechoic vascular structures adjacent to the testicle:



      • Figure 13.7—Varicocele


      • Video 13.5—Varicocele

       

    3. (c)


      Color Doppler will demonstrate pronounced vascular flow to these hypoechoic areas:



      • Figure 13.8—Varicocele with color Doppler


      • Video 13.6—Varicocele with color Doppler

       

    4. (d)


      Valsalva maneuver can increase size and flow pattern of varicoceles.

       

     

  3. 3.


    Testicular Torsion


    1. (a)


      Twisting of the spermatic cord results in venous congestion and obstruction followed by decreased arterial flow and eventually complete arterial obstruction leading to ischemia and infarction [1, 2].

       

    2. (b)


      Severity of torsion ranges from 180 to 720°, and complete occlusion of blood flow is thought to occur after 450° of torsion [2].

       

    3. (c)


      B-mode (2D) imaging:



      • The affected testicle will appear enlarged and hypoechoic with less homogeneity compared with the unaffected testicle.



        • Figure 13.9—Testicular torsion


        • Figure 13.10—Advanced testicular torsion


        • Video 13.7—Testicular torsion


      • The epididymis may appear hypoechoic and enlarged, similar to how it appears in epididymitis.

       

    4. (d)


      Color Doppler:

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Feb 27, 2018 | Posted by in ULTRASONOGRAPHY | Comments Off on Testicular Ultrasound

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