ULTRASOUND - SCROTUM

Alternative Names: scrotum ultrasound, scrotum sonography, ultrasound of the scrotum, scrotal ultrasound, scrotal sonography

ROLE OF SCROTUM ULTRASOUND

Ultrasound is essentially used to investigate causes for:

• Pain

  • Which side?

  • Dull or sharp?

  • Constant or intermittent?

  • Acute or chronic?

  • Does it travel higher?

• Mass

• Trauma

• Infertility

• Undescended testis

• H/o Trauma ,surgery or infection?

• Reduced Sperm count

• Varicocele

• Hydrocele

• Infections (orchitis,prostatitis)

• Polycystic kidney disease

• Cryptorchidism

LIMITATIONS

• It is recognised that ultrasound offers little or no diagnostic information for internal structures such as the cruciate ligaments. Ultrasound is complementary with other modalities, including plain X-ray, CT, MRI and arthroscopy.

EQUIPMENT SELECTION AND TECHNIQUE

• Use of a high resolution probe (7-15MHZ) is essential when assessing the internal structures of the scrotum.

• Low PRF and high gain colour / power / Doppler capabilities when assessing vessels of a testis.

• Be prepared to change frequency output of probe (or probes) to obtain accurate length measurements, an overview of pathology and anatomy to each other and adequately assess deeper structures in the abdomen if necessary.

SCANNING TECHNIQUE

• Use of a high resolution probe (7-15MHZ) is essential when assessing the internal structures of the scrotum.

• Low PRF and high gain colour / power / Doppler capabilities when assessing vessels of a testis.

• Be prepared to change frequency output of probe (or probes) to obtain accurate length measurements, an overview of pathology and anatomy to each other and adequately assess deeper structures in the abdomen if necessary.

PATIENT PREPARATION

• Must make sure the patient as comfortable

• Not only is this to put the patient at ease but you will get more information out of him which will give you better clues as to what the diagnosis will be.

• Using a towel or the patients gown, tuck the penis up over the symphasis to help elevate and immobilize the scrotum

• Use warm gel.

• Begin with a survey scan transversely down the scrotum to compare echogenicity of the testes.

• Scan each side independantly in both longitudinal and transverse planes.

• You may need to apply slight pressure to immobilze the testis as you scan. However, it is important to scan with minimal pressure to visualize fluid overlying the testis.

• Locate the epididymal head and follow in transverse down the body and tail.

• Assess both intra and extratesticular structures with power doppler.

• The Valsalva manoeuver or scanning in the upright position should be performed when evaluating for varicoceles or hernias.

• If a varicocele is identified, the scan should be extended to assess the testicular veins for the point of origin. Such as extratesticular masses that could be compressing the vein (eg pelvic lymphadenopathy)

• If a hernia is suspected, click here for hernia scanning protocol

COMMON PATHOLOGY

Extratesticular Lump or swelling

• Hydrocele

• Epididymitis, Orchitis or Epididymo-orchitis

• Epididymal Cysts

• Varicocele in the Pampiniform plexus

• Cryptorchidism or Maldescent

• Scrotal "Pearl"

• Microlithiasis (intratesticular)

Scrotal swelling with pain

4 main causes:

• Torsion (20%)

• Infection/inflammation (75-80%)

• Haemorrhage

• Strangulated Hernia

Torsion results in acute testicular infarction and eventually an atrophic testicle and constitutes a medical emergency. Quite often these patients will bypass the imaging department and go straight to theatre.

NOTE:

• epididymitis:torsion = 3:2 <20years

• epididymitis:torsion = 9:1 >20years

Intratesticular Lumps

• Germ Cell Tumours

• Seminoma

• Nonseminoma

SCROTUM ULTRASOUND SAMPLE PROTOCOL (TYPICALLY)

This sample protocol is meant for educational purposes and the exact technique will depend on the patient's clinical indication for the examination and the radiologist's guidance.

A scrotal series should include the following minimum images;

1. Transverse image showing both testes for comparitive echogenicity

2. Transverse imaging including both testes with color doppler to show comparative flow.

3. Transverse images of right testicle.

4. Vascularity of left testicle

5. Maximum transverse measurement of right testicle

6. Longitudinal images of right testicle

7. Maximum longitudinal measurement of right testicle

8. Epididymal head and body of right testicle

9. Spermatic cord of right testicle

10. Transverse images of left testicle

11. Vascularity of right testicle

12. Maximum transverse measurement of left testicle

13. Longitudinal images of left testicle

14. Maximum longitudinal measurement of left testicle

15. Epididymal head and body of left testicle

16. Spermatic cord of left testicle

Schedule Your Pelvic Ultrasound Today! 

• If you are looking for professional radiology services at your imaging site/center, call us at 1-800-626-8315 or contact us for a consultation. 

• If you live in Los Angeles, Century City, Glendale, Mid-Wilshire and need to schedule a radiology examination such as a MRI, CT Scan, Ultrasound, X ray, or PET scan, contact us to schedule an appointment. 

• If you are in search of other things, we're surprisingly resourceful!  Call us 1-800-626-8315 or contact us via our contact form.

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• scrotum ultrasound, scrotum sonography, ultrasound of the scrotum, scrotal ultrasound, scrotal sonography
• Ultrasound of the scrotum informational page including role of the scrotum ultrasound, limitations, equipment selection and technique, scanning technique, patient preparation, common pathology, and basic hard copy imaging.
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