Sonography of the Scrotum

Abstract

In this pictorial essay, we review and discuss the varying morphologic characteristics of scrotal appendages and calculi. Characteristic sonograms obtained from patients with coexisting hydrocele are presented, and recent literature is included. Hydrocele greatly facilitates the imaging of these intrascrotal structures, as it acts as a "water path". On the one hand, torsion of a scrotal appendage should always be included in the differential diagnosis of acute scrotum, especially in children. On the other hand, scrotolithiasis may occasionally cause mild discomfort. As a consequence, and given the widespread use of sonography for the evaluation of both acute and chronic conditions of the scrotum, radiologists should be familiar with these entities.

Pressed for time: The sonographic signs of testicular compartment syndrome

“…The TCS reported in these cases was likely to be secondary to epididymitis; an intra‐vaginal condition which is routinely diagnosed sonographically. Epididymitis is most frequently caused by bacterial infection, which migrates from the urethra into the epididymis 5,13 . Associated epidydimal swelling, hydroceles and pyoceles are well documented in the literature 6,14 In addition, although it is less common; abscess formation is another possible complication of epididymitis 4 .…”

“…REDF is a high resistance flow pattern indicative of antegrade flow during systole and retrograde flow during diastole which results in a loss of tissue perfusion 12 . It is therefore critical to utilise spectral Doppler when assessing the testicles and recognise REDF as an indication of impending testicular infarction 13,14,16 . The urgency of intervention is highlighted by case two as the patient's condition deteriorated from TCS to an infarcted testicle in less than 24 h.…”

“…REDF in any context should be treated with urgency as it indicates impending infarction and there is limited time to save the vascular supply. REDF should be used to assess for TCS in the presence of hydroceles/pyoceles/epididymitis and abscesses 1,13 …”

“…Epididymitis is most frequently caused by bacterial infection, which migrates from the urethra into the epididymis. 5,13 Associated epidydimal swelling, hydroceles and pyoceles are well documented in the literature 6,14 In addition, although it is less common; abscess formation is another possible complication of epididymitis. 4 Although the evidence is limited, it is thought that hydroceles, pyoceles and abscesses can cause alteration of testicular shape and compression of the testicular vein, artery and lymphatics which can increase the resistive index of the testicle.…”

“…12 It is therefore critical to utilise spectral Doppler when assessing the testicles and recognise REDF as an indication of impending testicular infarction. 13,14,16 The urgency of intervention is highlighted by case two as the patient's condition deteriorated from TCS to an infarcted testicle in less than 24 h.…”