Ultrasound of the Acute Scrotum

Phebe Chen, MD, Susan John, MD


Appl Radiol. 2006;35(3):8-17. 

In This Article

Miscellaneous Scrotal Abnormalities

Epididymal cysts and spermatoceles are common at all ages. Both types of lesions can be multiple, and about 30% of cases are asymptomatic.[6] Both types of cysts are thought to result from dilatation of the epididymal tubules. Epididymal cysts contain clear serous fluid, and spermatoceles generally contain spermatozoa and cellular debris. The sonographic appearance of these cysts is similar; however, epididymal cysts can occur anywhere, while spermatoceles occur only in the epididymal head.[4] Tubular ectasia of the rete testis can present as multiple cystic lesions, but its characteristic location near the mediastinum testis should prompt the diagnosis. Benign testicular cysts include tunical albuginea cysts, testicular cysts, and epidermoids (keratocysts).[2]

An undescended testis is one of the most common genitourinary anomalies in male infants. Cryptorchidism is found in 3.5% of term male infants at birth. Cryptorchidism is usually unilateral, but up to 30% of cases are bilateral. Associated urologic anomalies can be seen in up to 20% of patients with an undescended testis. The undescended testis is most commonly located at or just below the inguinal canal (Figure 14). Patients with an undescended testis are at higher risk for malignancy, torsion, infertility, and incarcerated inguinal hernia.[4] The risk of death from testicular malignancy in men with an undescended testis is nearly 10 times the risk in normal men, and the risk is increased in both the undescended testis after orchiopexy and within the normally descended testis.[2]

This 30-year-old patient desires testicular implant. The ultrasonographic finding of a hypoplastic right testicle in the right groin (arrows) from a previously undiagnosed cryptorchidism obviates the need for exploration prior to testicular implant. Note the discrepancy in size, but similar echotexture to the normal left testicle.

Macroscopic calcifications within the scrotum can be intratesticular or extratesticular. Intratesticular macrocalcifications may be associated with large cell calcifying Sertoli cell tumor, burned-out germ cell tumor,[6] or dystrophic calcifications from prior trauma.[4] In the epididymis, macrocalcifications may be the result of inflammation or trauma. Scrotoliths (scrotal pearls) -- calcified bodies within the scrotum with no clinical importance -- may represent loose bodies caused by torsion of the appendix testis or epididymis[4] (Figure 15).

Scrotal pearl or benign scrotal macrolith (arrows) may be the result of prior trauma or infection.


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