Seminars in Ultrasound, CT and MRI
Volume 28, Issue 4 , Pages 225-248 , August 2007

Ultrasound of the Scrotum

  • Monica Smith Pearl, MD
  • ,
  • Michael C. Hill, MB

      Affiliations

    • Corresponding Author InformationAddress reprint requests to Michael C. Hill, MB, Department of Radiology, The George Washington University Hospital, 900 23rd Street NW, Washington, DC 20037.

References 

  1. Martin B, Conte J. Ultrasonography of the acute scrotum. J Clin Ultrasound. 1987;15(1):37–44
  2. Dogra VS, Gottlieb RH, Oka M, et al. Sonography of the scrotum. Radiology. 2003;227(1):18–36
  3. Tessler FN, Tublin ME, Rifkin MD. Ultrasound assessment of testicular and paratesticular masses. J Clin Ultrasound. 1996;24(8):423–436
  4. Sudakoff GS, Quiroz F, Karcaaltincaba M, et al. Scrotal ultrasonography with emphasis on the extratesticular space: anatomy, embryology, and pathology. Ultrasound Q. 2002;18(4):255–273
  5. Casalino DD, Kim R. Clinical importance of a unilateral striated pattern seen on sonography of the testicle. AJR Am J Roentgenol. 2002;178(4):927–930
  6. Fakhry J, Khoury A, Barakat K. The hypoechoic band: a normal finding on testicular sonography. AJR Am J Roentgenol. 1989;153(2):321–323
  7. Black JA, Patel A. Sonography of the normal extratesticular space. AJR Am J Roentgenol. 1996;167(2):503–506
  8. Puttemans T, Delvigne A, Murillo D. Normal and variant appearances of the adult epididymis and vas deferens on high-resolution sonography. J Clin Ultrasound. 2006;34(8):385–392
  9. Horstman WG. Scrotal imaging. Urol Clin North Am. 1997;24(3):653–671
  10. Johnson KA, Dewbury KC. Ultrasound imaging of the appendix testis and appendix epididymis. Clin Radiol. 1996;51(5):335–337
  11. Gooding GA. Sonography of the spermatic cord. AJR Am J Roentgenol. 1988;151(4):721–724
  12. Middleton WD, Thorne DA, Melson GL. Color Doppler ultrasound of the normal testis. AJR Am J Roentgenol. 1989;152(2):293–297
  13. Middleton WD, Bell MW. Analysis of intratesticular arterial anatomy with emphasis on transmediastinal arteries. Radiology. 1993;189(1):157–160
  14. Pepe P, Panella P, Pennisi M, et al. Does color Doppler sonography improve the clinical assessment of patients with acute scrotum?. Eur J Radiol. 2006;60(1):120–124
  15. Moudy PC, Makhija JS. Ultrasonic demonstration of a non-palpable testicular tumor. J Clin Ultrasound. 1983;11(1):54–55
  16. Schwerk WB, Schwerk WN, Rodeck G. Testicular tumors: prospective analysis of real-time US patterns and abdominal staging. Radiology. 1987;164(2):369–374
  17. Carmignani L, Gadda F, Gazzano G, et al. High incidence of benign testicular neoplasms diagnosed by ultrasound. J Urol. 2003;170(5):1783–1786
  18. Carroll BA, Gross DM. High-frequency scrotal sonography. AJR Am J Roentgenol. 1983;140(3):511–515
  19. Powell TM, Tarter TH. Management of nonpalpable incidental testicular masses. J Urol. 2006;176(1):96–98discussion 99
  20. Glazer HS, Lee JK, Melson GL, et al. Sonographic detection of occult testicular neoplasms. AJR Am J Roentgenol. 1982;138(4):673–675
  21. Stoll S, Goldfinger M, Rothberg R, et al. Incidental detection of impalpable testicular neoplasm by sonography. AJR Am J Roentgenol. 1986;146(2):349–350
  22. Kirschling RJ, Kvols LK, Charboneau JW, et al. High-resolution ultrasonographic and pathologic abnormalities of germ cell tumors in patients with clinically normal testes. Mayo Clin Proc. 1983;58(10):648–653
  23. Grantham JG, Charboneau JW, James EM, et al. Testicular neoplasms: 29 tumors studied by high-resolution US. Radiology. 1985;157(3):775–780
  24. Frates MC, Benson CB, DiSalvo DN, et al. Solid extratesticular masses evaluated with sonography: pathologic correlation. Radiology. 1997;204(1):43–46
  25. Beccia DJ, Krane RJ, Olsson CA. Clinical management of non-testicular intrascrotal tumors. J Urol. 1976;116(4):476–479
  26. Fernandez-Perez GC, Tardaguila FM, Velasco M, et al. Radiologic findings of segmental testicular infarction. AJR Am J Roentgenol. 2005;184(5):1587–1593
  27. Horstman WG, Melson GL, Middleton WD, et al. Testicular tumors: findings with color Doppler US. Radiology. 1992;185(3):733–737
  28. Luker GD, Siegel MJ. Pediatric testicular tumors: evaluation with gray-scale and color Doppler US. Radiology. 1994;191(2):561–564
  29. Cheville JC. Classification and pathology of testicular germ cell and sex cord-stromal tumors. Urol Clin North Am. 1999;26(3):595–609
  30. Mostofi FK, Davis J, Rehm S. Tumours of the testis. IARC Sci Publ. 1994;111:407–429
  31. Benson CB, Deligdish CK, Loughlin KR. Sonographic detection of testicular plasmacytoma. J Clin Ultrasound. 1987;15(7):490–493
  32. Gierke CL, King BF, Bostwick DG, et al. Large-cell calcifying Sertoli cell tumor of the testis: appearance at sonography. AJR Am J Roentgenol. 1994;163(2):373–375
  33. Shawker TH, Javadpour N, O’Leary T, et al. Ultrasonographic detection of “burned-out” primary testicular germ cell tumors in clinically normal testes. J Ultrasound Med. 1983;2(10):477–479
  34. Emory TH, Charboneau JW, Randall RV, et al. Occult testicular interstitial-cell tumor in a patient with gynecomastia: ultrasonic detection. Radiology. 1984;151(2):474
  35. Soria JC, Durdux C, Chretien Y, et al. Malignant Leydig cell tumor of the testis associated with Klinefelter’s syndrome. Anticancer Res. 1999;19(5C):4491–4494
  36. Maizlin ZV, Belenky A, Kunichezky M, et al. Leydig cell tumors of the testis: gray scale and color Doppler sonographic appearance. J Ultrasound Med. 2004;23(7):959–964
  37. Giglio M, Medica M, De Rose AF, et al. Testicular sertoli cell tumours and relative sub-types (Analysis of clinical and prognostic features). Urol Int. 2003;70(3):205–210
  38. Young S, Gooneratne S, Straus FH, et al. Feminizing Sertoli cell tumors in boys with Peutz-Jeghers syndrome. Am J Surg Pathol. 1995;19(1):50–58
  39. Proppe KH, Scully RE. Large-cell calcifying Sertoli cell tumor of the testis. Am J Clin Pathol. 1980;74(5):607–619
  40. Noszian IM, Balon R, Eitelberger FG, et al. Bilateral testicular large-cell calcifying sertoli cell tumor and recurrent cardiac myxoma in a patient with Carney’s complex. Pediatr Radiol. 1995;25(suppl 1):S236–S237
  41. Carney JA, Gordon H, Carpenter PC, et al. The complex of myxomas, spotty pigmentation, and endocrine overactivity. Medicine (Baltimore). 1985;64(4):270–283
  42. Washecka R, Dresner MI, Honda SA. Testicular tumors in Carney’s complex. J Urol. 2002;167(3):1299–1302
  43. Tepperman BS, Gospodarowicz MK, Bush RS, et al. Non-Hodgkin lymphoma of the testis. Radiology. 1982;142(1):203–208
  44. Mazzu D, Jeffrey RB, Ralls PW. Lymphoma and leukemia involving the testicles: findings on gray-scale and color Doppler sonography. AJR Am J Roentgenol. 1995;164(3):645–647
  45. Doll DC, Weiss RB. Malignant lymphoma of the testis. Am J Med. 1986;81(3):515–524
  46. Moller MB, d’Amore F, Christensen BE. Testicular lymphoma: a population-based study of incidence, clinicopathological correlations and prognosis (The Danish Lymphoma Study Group, LYFO). Eur J Cancer. 1994;30A(12):1760–1764
  47. Phillips G, Kumari-Subaiya S, Sawitsky A. Ultrasonic evaluation of the scrotum in lymphoproliferative disease. J Ultrasound Med. 1987;6(4):169–175
  48. McDermott MB, O’Briain DS, Shiels OM, et al. Malignant lymphoma of the epididymis (A case report of bilateral involvement by a follicular large cell lymphoma). Cancer. 1995;75(8):2174–2179
  49. Rayor RA, Scheible W, Brock WA, et al. High resolution ultrasonography in the diagnosis of testicular relapse in patients with acute lymphoblastic leukemia. J Urol. 1982;128(3):602–603
  50. Anghel G, Petti N, Remotti D, et al. Testicular plasmacytoma: report of a case and review of the literature. Am J Hematol. 2002;71(2):98–104
  51. Ferry JA, Young RH, Scully RE. Testicular and epididymal plasmacytoma: a report of 7 cases, including three that were the initial manifestation of plasma cell myeloma. Am J Surg Pathol. 1997;21(5):590–598
  52. Grignon DJ, Shum DT, Hayman WP. Metastatic tumours of the testes. Can J Surg. 1986;29(5):359–361
  53. Johansson JE, Lannes P. Metastases to the spermatic cord, epididymis and testicles from carcinoma of the prostate–five cases. Scand J Urol Nephrol. 1983;17(2):249–251
  54. Bhatt S, Rubens DJ, Dogra VS. Sonography of benign intrascrotal lesions. Ultrasound Q. 2006;22(2):121–136
  55. Dogra VS, Gottlieb RH, Rubens DJ, et al. Benign intratesticular cystic lesions: US features. Radiographics. 2001;21(Spec No.):S273–S281
  56. Gooding GA, Leonhardt W, Stein R. Testicular cysts: US findings. Radiology. 1987;163(2):537–538
  57. Martinez-Berganza MT, Sarria L, Cozcolluela R, et al. Cysts of the tunica albuginea: sonographic appearance. AJR Am J Roentgenol. 1998;170(1):183–185
  58. Hamm B, Fobbe F, Loy V. Testicular cysts: differentiation with US and clinical findings. Radiology. 1988;168(1):19–23
  59. Nistal M, Iniguez L, Paniagua R. Cysts of the testicular parenchyma and tunica albuginea. Arch Pathol Lab Med. 1989;113(8):902–906
  60. Poster RB, Spirt BA, Tamsen A, et al. Complex tunica albuginea cyst simulating an intratesticular lesion. Urol Radiol. 1991;13(2):129–132
  61. Loya AG, Said JW, Grant EG. Epidermoid cyst of the testis: radiologic-pathologic correlation. Radiographics. 2004;24(suppl 1):S243–S246
  62. Atchley JT, Dewbury KC. Ultrasound appearances of testicular epidermoid cysts. Clin Radiol. 2000;55(7):493–502
  63. Sanderson AJ, Birch BR, Dewbury KC. Case report: multiple epidermoid cysts of the testes—the ultrasound appearances. Clin Radiol. 1995;50(6):414–415
  64. Stein MM, Stein MW, Cohen BC, et al. Unusual sonographic appearance of an epidermoid cyst of the testis. J Ultrasound Med. 1999;18(10):723–726
  65. Brown DL, Benson CB, Doherty FJ, et al. Cystic testicular mass caused by dilated rete testis: sonographic findings in 31 cases. AJR Am J Roentgenol. 1992;158(6):1257–1259
  66. Weingarten BJ, Kellman GM, Middleton WD, et al. Tubular ectasia within the mediastinum testis. J Ultrasound Med. 1992;11(7):349–353
  67. Tartar VM, Trambert MA, Balsara ZN, et al. Tubular ectasia of the testicle: sonographic and MR imaging appearance. AJR Am J Roentgenol. 1993;160(3):539–542
  68. Piotto L, LeQuesne GW, Gent R, et al. Congenital cystic dysplasia of the rete testis. Pediatr Radiol. 2001;31:724–726
  69. Cast JE, Nelson WM, Early AS, et al. Testicular microlithiasis: prevalence and tumor risk in a population referred for scrotal sonography. AJR Am J Roentgenol. 2000;175(6):1703–1706
  70. Janzen DL, Mathieson JR, Marsh JI, et al. Testicular microlithiasis: sonographic and clinical features. AJR Am J Roentgenol. 1992;158(5):1057–1060
  71. Middleton WD, Teefey SA, Santillan CS. Testicular microlithiasis: prospective analysis of prevalence and associated tumor. Radiology. 2002;224(2):425–428
  72. Bennett HF, Middleton WD, Bullock AD, et al. Testicular microlithiasis: US follow-up. Radiology. 2001;218(2):359–363
  73. Kragel PJ, Delvecchio D, Orlando R, et al. Ultrasonographic findings of testicular microlithiasis associated with intratubular germ cell neoplasia. Urology. 1991;37(1):66–68
  74. Zastrow S, Hakenberg OW, Wirth MP. Significance of testicular microlithiasis. Urol Int. 2005;75(1):3–7
  75. Vachon L, Fareau GE, Wilson MG, et al. Testicular microlithiasis in patients with Down syndrome. J Pediatr. 2006;149(2):233–236
  76. Sakamoto H, Shichizyou T, Saito K, et al. Testicular microlithiasis identified ultrasonographically in Japanese adult patients: prevalence and associated conditions. Urology. 2006;68(3):636–641
  77. Kim B, Winter TC, Ryu JA. Testicular microlithiasis: clinical significance and review of the literature. Eur Radiol. 2003;13(12):2567–2576
  78. Otite U, Webb JA, Oliver RT, et al. Testicular microlithiasis: is it a benign condition with malignant potential. Eur Urol. 2001;40(5):538–542
  79. Bach AM, Hann LE, Hadar O, et al. Testicular microlithiasis: what is its association with testicular cancer?. Radiology. 2001;220(1):70–75
  80. Eraso CE, Vrachliotis TG, Cunningham JJ. Sonographic findings in testicular sarcoidosis simulating malignant nodule. J Clin Ultrasound. 1999;27(2):81–83
  81. Winter TC, Keener TS, Mack LA. Sonographic appearance of testicular sarcoid. J Ultrasound Med. 1995;14(2):153–156
  82. Avila NA, Shawker TS, Jones JV, et al. Testicular adrenal rest tissue in congenital adrenal hyperplasia: serial sonographic and clinical findings. AJR Am J Roentgenol. 1999;172(5):1235–1238
  83. Vanzulli A, DelMaschio A, Paesano P, et al. Testicular masses in association with adrenogenital syndrome: US findings. Radiology. 1992;183(2):425–429
  84. Avila NA, Premkumar A, Shawker TH, et al. Testicular adrenal rest tissue in congenital adrenal hyperplasia: findings at Gray-scale and color Doppler US. Radiology. 1996;198(1):99–104
  85. Rosenfield AT, Blair DN, McCarthy S, et al. Society of Uroradiology Award paper (The pars infravaginalis gubernaculi: importance in the identification of the undescended testis). AJR Am J Roentgenol. 1989;153(4):775–778
  86. Friedland GW, Chang P. The role of imaging in the management of the impalpable undescended testis. AJR Am J Roentgenol. 1988;151(6):1107–1111
  87. Kolon TF, Patel RP, Huff DS. Cryptorchidism: diagnosis, treatment, and long-term prognosis. Urol Clin North Am. 2004;31(3):469–480viii-ix
  88. Akin EA, Khati NJ, Hill MC. Ultrasound of the scrotum. Ultrasound Q. 2004;20(4):181–200
  89. Weiss RM, Carter AR, Rosenfield AT. High resolution real-time ultrasonography in the localization of the undescended testis. J Urol. 1986;135(5):936–938
  90. Beomonte Zobel B, Vicentini C, Masciocchi C, et al. Magnetic resonance imaging in the localization of undescended abdominal testes. Eur Urol. 1990;17(2):145–148
  91. Kier R, McCarthy S, Rosenfield AT, et al. Nonpalpable testes in young boys: evaluation with MR imaging. Radiology. 1988;169(2):429–433
  92. Oh C, Nisenbaum HL, Langer J, et al. Sonographic demonstration, including color Doppler imaging, of recurrent sperm granuloma. J Ultrasound Med. 2000;19(5):333–335
  93. Dunner PS, Lipsit ER, Nochomovitz LE. Epididymal sperm granuloma simulating a testicular neoplasm. J Clin Ultrasound. 1982;10(7):353–355
  94. Ishizaka K, Kamai T, Gotoh S, et al. Epididymal sperm invasion apparently suggestive of a testicular tumor. Hinyokika Kiyo. 1994;40(2):161–163
  95. Makarainen HP, Tammela TL, Karttunen TJ, et al. Intrascrotal adenomatoid tumors and their ultrasound findings. J Clin Ultrasound. 1993;21(1):33–37
  96. Wernert N, Goebbels R, Prediger L. Papillary cystadenoma of the epididymis (Case report and review of the literature). Pathol Res Pract. 1986;181(2):260–264
  97. Krainik A, Sarrazin JL, Camparo P, et al. Fibrous pseudotumor of the epididymis: imaging and pathologic correlation. Eur Radiol. 2000;10(10):1636–1638
  98. Germaine P, Simerman LP. Fibrous pseudotumor of the scrotum. J Ultrasound Med. 2007;26(1):133–138
  99. Einstein DM, Paushter DM, Singer AA, et al. Fibrotic lesions of the testicle: sonographic patterns mimicking malignancy. Urol Radiol. 1992;14(3):205–210
  100. Tobias-Machado M, Correa Lopes Neto A, Heloisa Simardi L, et al. Fibrous pseudotumor of tunica vaginalis and epididymis. Urology. 2000;56(4):670–672
  101. Smith FJ, Bilbey JH, Filipenko JD, et al. Testicular pseudotumor in the acquired immunodeficiency syndrome. Urology. 1995;45(3):535–537
  102. Pekindil G, Huseyin Atakan I, Kaya E, et al. Bilateral synchronous granulomatous orchitis: gray-scale and colour Doppler sonographic findings. Eur J Radiol. 1999;31(3):201–203
  103. Muttarak M, Peh WC, Lojanapiwat B, et al. Tuberculous epididymitis and epididymo-orchitis: sonographic appearances. AJR Am J Roentgenol. 2001;176(6):1459–1466
  104. Chung JJ, Kim MJ, Lee T, et al. Sonographic findings in tuberculous epididymitis and epididymo-orchitis. J Clin Ultrasound. 1997;25(7):390–394
  105. Ozturk A, Ozturk E, Zeyrek F, et al. Comparison of brucella and non-specific epididymorchitis: gray scale and color Doppler ultrasonographic features. Eur J Radiol. 2005;56(2):256–262
  106. Basekim CC, Kizilkaya E, Pekkafali Z, et al. Mumps epididymo-orchitis: sonography and color Doppler sonographic findings. Abdom Imaging. 2000;25(3):322–325
  107. Horstman WG, Middleton WD, Melson GL. Scrotal inflammatory disease: color Doppler US findings. Radiology. 1991;179(1):55–59
  108. Farriol VG, Comella XP, Agromayor EG, et al. Gray-scale and power Doppler sonographic appearances of acute inflammatory diseases of the scrotum. J Clin Ultrasound. 2000;28(2):67–72
  109. Brown JM, Hammers LW, Barton JW, et al. Quantitative Doppler assessment of acute scrotal inflammation. Radiology. 1995;197(2):427–431
  110. Cook JL, Dewbury K. The changes seen on high-resolution ultrasound in orchitis. Clin Radiol. 2000;55(1):13–18
  111. Mevorach RA, Lerner RM, Dvoretsky PM, et al. Testicular abscess: diagnosis by ultrasonography. J Urol. 1986;136(6):1213–1216
  112. Jafri SZ, Bree RL, Madrazo BL, et al. Sonography of large scrotal infections. J Clin Ultrasound. 1991;19(7):413–418
  113. Buckley JC, McAninch JW. Use of ultrasonography for the diagnosis of testicular injuries in blunt scrotal trauma. J Urol. 2006;175(1):175–178
  114. Learch TJ, Hansch LP, Ralls PW. Sonography in patients with gunshot wounds of the scrotum: imaging findings and their value. AJR Am J Roentgenol. 1995;165(4):879–883
  115. Cohen HL, Shapiro ML, Haller JO, et al. Sonography of intrascrotal hematomas simulating testicular rupture in adolescents. Pediatr Radiol. 1992;22(4):296–297
  116. Gordon LM, Stein SM, Ralls PW. Traumatic epididymitis: evaluation with color Doppler sonography. AJR Am J Roentgenol. 1996;166(6):1323–1325
  117. Gooding GA, Leonhardt WC, Marshall G, et al. Cholesterol crystals in hydroceles: sonographic detection and possible significance. AJR Am J Roentgenol. 1997;169(2):527–529
  118. Meacham RB, Townsend RR, Rademacher D, et al. The incidence of varicoceles in the general population when evaluated by physical examination, gray scale sonography and color Doppler sonography. J Urol. 1994;151(6):1535–1538
  119. Gonda RL, Karo JJ, Forte RA, et al. Diagnosis of subclinical varicocele in infertility. AJR Am J Roentgenol. 1987;148(1):71–75
  120. Mehta AL, Dogra VS. Intratesticular varicocele. J Clin Ultrasound. 1998;26(1):49–51
  121. Pierik FH, Dohle GR, van Muiswinkel JM, et al. Is routine scrotal ultrasound advantageous in infertile men?. J Urol. 1999;162(5):1618–1620
  122. Rifkin MD, Foy PM, Kurtz AB, et al. The role of diagnostic ultrasonography in varicocele evaluation. J Ultrasound Med. 1983;2(6):271–275
  123. Graif M, Hauser R, Hirshebein A, et al. Varicocele and the testicular-renal venous route: hemodynamic Doppler sonographic investigation. J Ultrasound Med. 2000;19(9):627–631
  124. Kocakoc E, Serhatlioglu S, Kiris A, et al. Color Doppler sonographic evaluation of inter-relations between diameter, reflux and flow volume of testicular veins in varicocele. Eur J Radiol. 2003;47(3):251–256
  125. Tasci AI, Resim S, Caskurlu T, et al. Color Doppler ultrasonography and spectral analysis of venous flow in diagnosis of varicocele. Eur Urol. 2001;39(3):316–321
  126. Kessler A, Meirsdorf S, Graif M, et al. Intratesticular varicocele: gray scale and color Doppler sonographic appearance. J Ultrasound Med. 2005;24(12):1711–1716
  127. Atasoy C, Fitoz S. Gray-scale and color Doppler sonographic findings in intratesticular varicocele. J Clin Ultrasound. 2001;29(7):369–373
  128. Eftekhari F, Smith JK. Sonography of the scrotum after orchiectomy: normal and abnormal findings. AJR Am J Roentgenol. 1993;160(3):543–547
  129. Furtschegger A, Sandbichler P, Judmaier W, et al. Sonography in the postoperative evaluation of laparoscopic inguinal hernia repair. J Ultrasound Med. 1995;14(9):679–684

PII: S0887-2171(07)00043-1

doi: 10.1053/j.sult.2007.05.001

Seminars in Ultrasound, CT and MRI
Volume 28, Issue 4 , Pages 225-248 , August 2007