Ultrasound of the Acute Scrotum

Phebe Chen, MD, Susan John, MD

Disclosures

Appl Radiol. 2006;35(3):8-17. 

In This Article

Sonography

On US, the pediatric testes are ovoid, measuring approximately 1 cm[3] with uniform low-to-medium echogenicity (Figure 1). The size and echogenicity increases from age 8 to puberty, at which time the testes are about 4 cm3. In the adult, the normal testis is roughly 20 cm3, with an approximate diameter of 3 to 5 cm, which decreases with age.[4] The mediastinum testis can be seen as a linear echogenic band. The trans-mediastinal artery, if present, appears as a prominent intratesticular hypoechoic band with opposite direction of flow from the recurrent rami (Figure 2). The epididymis has an echogenicity similar to or slightly hyperechoic to the testis. The epididymal head may be round or triangular, measures 5 to 12 mm in length, and lies atop the superior pole of the testis (see Figure 1), while the body and tail run posterior to the testis. The narrow body (2 to 4 mm) and tail (2 to 5 mm) are often indistinguishable from surrounding tissues but may occasionally be seen in normal patients with high-resolution US.[2,4] A small amount of fluid between the leaves of the tunica vaginalis is seen in most normal patients. The appendix testis is attached to the upper pole of the testis in the groove between the testis and the epididymis, while the appendix epididymis is attached to the head of the epididymis. These structures are seen only when torsed or when a hydrocele is present[2,3,4] (Figure 3). The normal scrotal skin measures 2 to 8 mm in thickness.[6]

Longitudinal sonographic image of a normal testicle showing homogeneous echotexture. The normal epididymal head (arrow) is located superior to the testis.

Transmediastinal artery. (A) A prominent tubular structure is seen traversing the mediastinum testis (arrows), (B) which shows flow coursing toward the periphery of the testis.

Transmediastinal artery. (A) A prominent tubular structure is seen traversing the mediastinum testis (arrows), (B) which shows flow coursing toward the periphery of the testis.

A normal appendix testis (arrow) is easily visualized in the presence of a hydrocele.

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