Ultrasound: testicular

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
  • 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

Testicular Torsion

Epididymitis

Hydrocele

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

Abnormal

Testicular Torsion

External Links

• Sonoguide: Small Parts - Testicular Ultrasound

See Also

• Ultrasound (Main)
• Testicular diagnoses