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The use of scrotal ultmsonogmphy has been advanced with the development of high-resolution real-time equipment. A group of 284 consecutive patients referred for scrotal examination was studied ultrasonically and followed over a three-year period. Abnormal scrotal contents were accurately detected in 98.5 per cent of cases. Sepamtion of testicular from extratesticular pathology was 99 per cent accurate. While all malignant testicular lesions could be identified, there were examples which could not be differentiated from benign lesions prior to surgical exploration and biopsy. However, there are many examples where the ultrasound results can change clinical management of the patient. (Key words: scrotal ultrasonography; testicular ultrasound; testis, pathology)Prior to the use of ultrasound examination of the scrotum, accurate diagnosis of most testicular lesions required surgical exploration. The develop· ment of diagnostic sonography has permitted evaluation of testicular abnormalities since the tech-· nique was described in 1978. 1 Initially, scrotal examinations were performed using the contact B· scan technique that required a high degree of opemtor experience. With the recent development of high-resolution real-time small parts ultrasound equipment, scanning technique and the resolution of the image have improved significantly. ~-.f Smaller lesions can be identified, with detection of cancers less than 1 em reported. 3 · while some pre· liminary studies have suggested the benefits of scrotal ultrasonography, these have involved small numbers of subjects or a limited range of pathology, or were retrospective studies. 3 -9 We have undertaken a large, long•term prospective study to evaluate the use of scrotal ultrasonography in detecting and differentiating abnormalities prior to operative confirmation in an attempt to define the usefulness of this procedure.

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Placenta increta, invasion of the myometrium by normal placental (chorionic) villi, can be life-threatening to a mother at delivery. In two reported cases of pathologically proven placenta increta, the abnormal areas were retrospectively identified on ultrasonographic images. In both cases, there was consistent focal obliteration of the hypoechoic retroplacental zone by either tissue of echogenicity similar to that of the normal placenta or tissue of slightly decreased echogenicity. This was found to represent extension of the villi through the decidua basalis into the myometrium. The spectrum of non-malignant invasive placentas and the specific ultrasonographic findings that should allow prospective diagnosis are discussed.

Twenty‐one patients with the clinical diagnosis of varicocele were evaluated with static and superficial organ scanners. The sonogram was able to image the dilated scrotal veins in all of these cases. The small, clinically subtle varicocele could be demonstrated only with high‐resolution, dedicated real‐time small‐parts scanners, whereas larger lesions could also be imaged with B‐mode contact equipment. Varicoceles are a well‐documented cause of male infertility amenable to surgical treatment. From this study it is felt that ultrasonography can accurately detect varicoceles. It can be used as a screening procedure so that only those men requiring therapy need undergo more extensive and complicated diagnostic procedures.

Polyorchidism, or multiple testes, is a rare condition that has been referred to in both medical literature and mythological folklore. Curious attributes have been ascribed to men with this condition, including supposed increased sexual prowess and virility. In the medical literature, the examples of supernumerary testicles have demonstrated only one additional testis. The first proven case of an extra testicle was by Lane, in 1895. Boggon reviewed 11 additional cases in 1933, and numerous other cases have been reported since then. To date, there has not been a preoperative ultrasonographic study that adequately describes this phenomenon.