Epididymal Appearance in Congenital Absence of Vas Deferens

Abstract

Scrotal sonography was performed in the infertile males. Sonography of epididymis was performed to document its presence, appearance, echo texture and duct ectasia. The spermatic cord was examined to document the status of the vas deferens. TRUS was performed to look for distal vas. Epididymal abnormalities were universal in men with congenital bilateral absence of vas deferens, with a sensitivity of 100%. Three types of abnormal appearances were recognized ‐ a honeycomb appearance, a fine meshwork pattern of head, or complete or partial absence of epididymis. Identification of these abnormalities can be a very sensitive marker for congenital bilateral absence of vas deferens.

Ultrasound of the Normal and Abnormal Vas Deferens

“…Therefore, the diagnosis of agenesis is based on nonvisualization of this segment. 12,18 As mentioned earlier, this depends on a combination of grayscale and Doppler imaging with and without graded compression (Figs. 15,16,17) Like the vas deferens, the epididymis arises from the Wolffian duct and may be atretic itself or altered due to obstruction.…”

“…However, studies have now shown that sonography is able to reliably identify the scrotal and extrapelvic portion of the vas deferens in normal volunteers [7][8][9][10] and to evaluate patients with obstructive azoospermia, including congenital absence of the vas. [10][11][12] These results indicate that evaluation of the extrapelvic vas deferens is now possible and at the least should become a standard part of the sonographic examination in patients with infertility. Before this technique can be applied broadly, it is important to be familiar with the normal and abnormal sonographic appearance of the vas deferens.…”

“…In almost all cases, there are associated changes in the epididymis, ranging from complete or partial atresia, various degrees of cystic changes, heterogeneity, and nodularity 18 . In a study of 85 men with CBAVD, abnormalities in the epididymis were universal 12 . The most common sonographic finding (n = 51, 61%) was replacement of the head of the epididymis by multiple small cysts (referred to as the honeycomb appearance) (Figs.…”

“…18 In a study of 85 men with CBAVD, abnormalities in the epididymis were universal. 12 The most common sonographic finding (n = 51, 61%) was replacement of the head of the epididymis by multiple small cysts (referred to as the honeycomb appearance) (Figs. 15A, B, and video 15C, http://links.lww.…”

“…Sonographic evaluation of the scrotum generally focuses on the testes and epididymides without any specific attention to the vas deferens. However, studies have now shown that sonography is able to reliably identify the scrotal and extrapelvic portion of the vas deferens in normal volunteers 7–10 and to evaluate patients with obstructive azoospermia, including congenital absence of the vas 10–12 . These results indicate that evaluation of the extrapelvic vas deferens is now possible and at the least should become a standard part of the sonographic examination in patients with infertility.…”