Ultrasound of the Acute Scrotum

Phebe Chen, MD, Susan John, MD

Disclosures

Appl Radiol. 2006;35(3):8-17. 

In This Article

Varicoceles

Varicocele represents abnormal dilatation and tortuosity of the veins of the pampiniform plexus within the spermatic cord, caused by incompetent valves in the internal spermatic vein. The condition is more common on the left and is idiopathic in 15% of males between 15 and 25 years of age.[2] About one third of men with varicocele will be infertile. The size of the varicocele does not affect the incidence of infertility.[9] On US, varicoceles appear as multiple hypoechoic serpiginous and tubular structures of varying sizes, predominantly >2 mm in diameter and located superior and lateral to the testis.[2,4] Echoes from slow blood flow may be seen within the dilated veins (Figure 10). Noncompressibility of a varicocele may indicate retroperitoneal malignancy or other causes of increased pressure on the spermatic vein. Ultrasound with color Doppler is highly sensitive for the diagnosis but requires scanning in both the supine and upright positions and during the Valsalva maneuver. Primary varicoceles may decompress when the patient is supine, but the flow within the veins increases when the patient is in an upright position and with the Valsalva maneuver.

(A) Several prominent tubular structures are present within the scrotal sac. (B) These structures reveal venous flow, which can be accentuated when the patient is in the upright position or during the Valsalva maneuver.

(A) Several prominent tubular structures are present within the scrotal sac. (B) These structures reveal venous flow, which can be accentuated when the patient is in the upright position or during the Valsalva maneuver.

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