Difference between revisions of "Testicular ultrasound"

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==Anatomy==
+
==Background==
*testicle - ~2 to 3 cm in width and 3 to 5 cm in length
+
[[File:Gray1144.png|thumb|Scrotal anatomy]]
*epididymis - along the posterolateral aspect of each testis
+
[[File:Figure 28 01 02.jpg|thumb|Scrotal anatomy]]
*vas deferens
+
[[File:Illu testis surface.jpg|thumb|1. Epididymis 2. Head of epididymis 3. Lobules of epididymis 4. Body of epididymis 5. Tail of epididymis 6. Duct of epididymis 7. Deferent duct (ductus deferens or vas deferens)]]
*spermatic cord
+
*Testicular torsion is a medical emergency where acute treatment is needed
*median raphe
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*Testicular salvage rate by time<ref>Patriquin HB, Yazbeck S, Trinh B, et al. Testicular torsion in infants and children: diagnosis with Doppler sonography. Radiology. 1993;188:781-785.</ref>
 +
**Near 100% within 6 hours
 +
**70% within 6-12 hours
 +
**20% within 12-24 hours
 +
===Anatomy===
 +
*Testicle - ~2 to 3 cm in width and 3 to 5 cm in length
 +
*Epididymis - along the posterolateral aspect of each testis
 +
*Vas Deferens
 +
*Spermatic cord
 +
*Median Raphe
 +
 
 +
==Indications==
 +
*Testicular pain or tenderness
 +
*Testicular swelling
  
 
==Technique==
 
==Technique==
*linear transducer
+
#Select probe
*scanned in longitudinal and transverse axis
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#*Linear probe
*first the unaffected hemiscrotum
+
#Location
*coronal scan showing both testicles side by side (Buddy View) should be performed to identify differences in size and echogenicity, and vascularity
+
#*Obtain anterior views over the scrotum
*Power Doppler examination on unaffected side for calibration of machine
+
#Landmarks
 +
#*Heterogeneous testicles can be seen under the soft tissues of the scrotum
 +
#Obtain sagittal and transverse images
 +
#*Initial view should be “buddy view” identifying both testicles in a tranverse plane with the middle of the probe over the scrotal raphe
 +
#*Each testicle should be examined in the transverse and sagittal plane
 +
#*Each testicle should be examined under power Doppler assessing blood flow
 +
#Optimize image quality
 +
#*Minimize depth to include only the body of the testicle
 +
#*When assessing blood flow, increase power Doppler to a level where vasculature can be easily identified
  
==Terms==
+
==Findings==
*hyperemia:inflammation and demonstrates no flow and lots of color with out a pulse
+
===Normal Testicle===
**Think orchitis and detorsed testicle
+
*Equal heterogeneity
 +
*Equal blood flow
 +
*Minimal fluid around the testicle
 +
===[[Testicular Torsion]]===
 +
*Enlarged testicle
 +
*Increased heterogeneity
 +
*Decreased flow on power Doppler
 +
**Increased flow may be seen in cases of torsion with subsequent detorsion
 +
===[[Epididymitis]]===
 +
*Enlarge epididymis
 +
*Increased epididymal blood flow
 +
*Normal testicular appearance
 +
*Compare flow to contralateral testicle
  
==Findings and DDX==
+
===[[Hydrocele]]===
*epididymitis - enlarged epididymis with decreased echogenicity
+
*Anechoic fluid adjacent to the testicle
*orchitis - enlarged testicle with heterogeneous echogenicity with increased blood flow
+
===[[Orchitis]]===
*hydrocele -  Abnormal collection of fluid in the space between the visceral and parietal layers of the tunica vaginalisin anterolateral portions
+
*Enlarged testicle
*varicocele -  left side, multiple anechoic serpiginous tubular or curvilinear structures of varying sizes (larger than 2 mm in diameter)
+
*Increased flow on power Doppler
*testicular torsion - power Doppler with absent blood flow in the affected testicle; patient can present early and still have flow
+
*Difficult to differentiate from recently detorsed testicle
*torsion of the testicular appendage
 
*testicular trauma
 
*herniation of abdominal contents into the scrotum - peristalsis of bowel
 
  
 +
==Images==
 +
===Normal===
 +
[[File:Normal testicular flow.JPG|250px]]
 +
===Abnormal===
 +
===[[Testicular Torsion]]===
 +
[[File:Testicular torsion.png|250px]]
 +
===[[Epididymitis]]===
 +
[[File:Epidydimitis.png|250px]]
 +
===[[Hydrocele]]===
 +
[[File:Small hydrocele.png|250px|White arrow]]
 +
 +
==Pearls and Pitfalls==
 +
*Adjust color flow on normal testicle first as a baseline to compare to painful or swollen testicle
 +
*Hyperemic testicle does not rule out testicular torsion as this could represent intermittent torsion or detorsion
 +
 +
==Documentation==
 +
===Normal Exam===
 +
A bedside ultrasound was conducted to assess for signs testicular torsion with clinical indications of right/left testicular pain. The right and left testicles were identified and viewed in the transverse and sagittal plane and assessed with power Doppler. Heterogenicity was similar and blood flow was similar. There was not indications of testicular torsion.
 +
===Abnormal Exam===
 +
A bedside ultrasound was conducted to assess for signs testicular torsion with clinical indications of right/left testicular pain. The right and left testicles were identified and viewed in the transverse and sagittal plane and assessed with power Doppler. The right/left testicle has increased heterogenicity and diminished blood flow. Findings indicate testicular torsion.
 +
 +
==Clips==
 +
===Normal===
 +
[[File:Normal testicular flow.gif|250px|Normal testicular blood flow]]
 +
 +
===Abnormal===
 +
====Testicular Torsion====
 +
[[File:Testicular torsion.gif|250px|Absent testicular blood flow]]
 +
 +
==External Links==
 +
*[http://www.sonoguide.com/smparts_testicular.html Sonoguide: Small Parts - Testicular Ultrasound]
 +
 
==See Also==
 
==See Also==
 
*[[Ultrasound (Main)]]
 
*[[Ultrasound (Main)]]
*[[Orchitis]]
+
*[[Testicular diagnoses]]
 +
 
 +
==References==
 +
<references/>
  
==Source==
+
[[Category:Ultrasound]]
*Sonosite
+
[[Category:Radiology]]
+
[[Category:Urology]]
[[Category: GU]]
 
[[Category: Rads]]
 

Latest revision as of 20:28, 4 June 2020

Background

Scrotal anatomy
Scrotal anatomy
1. Epididymis 2. Head of epididymis 3. Lobules of epididymis 4. Body of epididymis 5. Tail of epididymis 6. Duct of epididymis 7. Deferent duct (ductus deferens or vas deferens)
  • Testicular torsion is a medical emergency where acute treatment is needed
  • Testicular salvage rate by time[1]
    • Near 100% within 6 hours
    • 70% within 6-12 hours
    • 20% within 12-24 hours

Anatomy

  • Testicle - ~2 to 3 cm in width and 3 to 5 cm in length
  • Epididymis - along the posterolateral aspect of each testis
  • Vas Deferens
  • Spermatic cord
  • Median Raphe

Indications

  • Testicular pain or tenderness
  • Testicular swelling

Technique

  1. Select probe
    • Linear probe
  2. Location
    • Obtain anterior views over the scrotum
  3. Landmarks
    • Heterogeneous testicles can be seen under the soft tissues of the scrotum
  4. Obtain sagittal and transverse images
    • Initial view should be “buddy view” identifying both testicles in a tranverse plane with the middle of the probe over the scrotal raphe
    • Each testicle should be examined in the transverse and sagittal plane
    • Each testicle should be examined under power Doppler assessing blood flow
  5. Optimize image quality
    • Minimize depth to include only the body of the testicle
    • When assessing blood flow, increase power Doppler to a level where vasculature can be easily identified

Findings

Normal Testicle

  • Equal heterogeneity
  • Equal blood flow
  • Minimal fluid around the testicle

Testicular Torsion

  • Enlarged testicle
  • Increased heterogeneity
  • Decreased flow on power Doppler
    • Increased flow may be seen in cases of torsion with subsequent detorsion

Epididymitis

  • Enlarge epididymis
  • Increased epididymal blood flow
  • Normal testicular appearance
  • Compare flow to contralateral testicle

Hydrocele

  • Anechoic fluid adjacent to the testicle

Orchitis

  • Enlarged testicle
  • Increased flow on power Doppler
  • Difficult to differentiate from recently detorsed testicle

Images

Normal

Normal testicular flow.JPG

Abnormal

Testicular Torsion

Testicular torsion.png

Epididymitis

Epidydimitis.png

Hydrocele

White arrow

Pearls and Pitfalls

  • Adjust color flow on normal testicle first as a baseline to compare to painful or swollen testicle
  • Hyperemic testicle does not rule out testicular torsion as this could represent intermittent torsion or detorsion

Documentation

Normal Exam

A bedside ultrasound was conducted to assess for signs testicular torsion with clinical indications of right/left testicular pain. The right and left testicles were identified and viewed in the transverse and sagittal plane and assessed with power Doppler. Heterogenicity was similar and blood flow was similar. There was not indications of testicular torsion.

Abnormal Exam

A bedside ultrasound was conducted to assess for signs testicular torsion with clinical indications of right/left testicular pain. The right and left testicles were identified and viewed in the transverse and sagittal plane and assessed with power Doppler. The right/left testicle has increased heterogenicity and diminished blood flow. Findings indicate testicular torsion.

Clips

Normal

Normal testicular blood flow

Abnormal

Testicular Torsion

Absent testicular blood flow

External Links

See Also

References

  1. Patriquin HB, Yazbeck S, Trinh B, et al. Testicular torsion in infants and children: diagnosis with Doppler sonography. Radiology. 1993;188:781-785.