Sonography of the scrotum after orchiectomy: normal and abnormal findings

Bizarre Scrotal Sonogram

A 48-year-old male who had undergone left inguinal orchidectomy for testicular tumor 10 days previously presented with left inguinal and scrotal swelling. The scrotal sonogram showed what appeared to be two testes, with a mass within the left testicular area. Real-time scanning revealed that the left “testis” was thick fluid/hematoma with a more organized hematoma within.

Postorchiectomy intrascrotal hematoma mimicking local recurrence on 18F-FDG PET/CT: a diagnostic dilemma

Intratesticular hematomas usually develop immediately after orchiectomy is done for testicular tumors and may last for 3 to 6 weeks or longer. They may be confused with local recurrence on clinical examination and imaging. We present the (18)F-fluorodeoxyglucose (FDG) positron emission tomography/computed tomography (PET/CT) images of a 30-year-old man who underwent right radical transinguinal orchiectomy for seminoma. PET/CT done 8 weeks after orchiectomy revealed a soft tissue lesion in the right scrotum with increased FDG uptake, suspicious for local recurrence. However, on color Doppler ultrasonography of the scrotum, the mass was confirmed to be a hematoma.

Ultrasound of the Scrotum

Ultrasound is a vital adjunct to clinical examination in diagnosing scrotal disease, as a number of different processes may present similarly. Potential applications range from the acute emergency to long-term screening as well as cases in which a distinct scrotal abnormality may or may not be palpable. Differentiating acute epididymitis/epididymoorchitis from testicular torsion is possible sonographically, thereby guiding appropriate medical or surgical management. Distinguishing between cystic, solid, or complex scrotal masses is readily performed with this modality. It clearly depicts simple versus complex hydroceles and determines the presence of underlying testicular or epididymal disease. Not only is ultrasound the best imaging modality for longitudinal screening in patients (testicular microlithiasis, cryptorchidism) at risk for testicular tumors, it also provides valuable information in the infertile male by documenting the presence or absence of a varicocele.

Sonography of Benign Intrascrotal Lesions

Ultrasound plays an important role and adds essential information in diagnosing benign intrascrotal lesions. Characterization of benign intrascrotal lesions with sonography, in combination with clinical assessment, can lead to nonsurgical management or testicular sparing surgery. We present important sonographic features of benign intrascrotal lesions, including extratesticular lesions: adenomatoid tumors, papillary cystadenomas, spermatoceles, hydroceles, varicoceles, hernias; and intratesticular lesions: tunica albuginea cysts, testicular simple cysts, epidermoid cysts, tubular ectasia of the rete testis, intratesticular varicoceles, adrenal rest tumors, and splenogonadal fusion. The goal of this review is to provide the radiologist with a better understanding of benign lesions that occur in the scrotum.

Sonography of the scrotum

Ultrasonography (US) with a high-frequency (7.5-10-MHz) transducer has become the imaging modality of choice for examination of the scrotum. US examination can provide information valuable for the differential diagnosis of a variety of disease processes involving the scrotum that have similar clinical manifestations (eg, pain, swelling, or presence of mass). The pathologic condition that may be at the origin of such symptoms can vary from testicular torsion to infection to malignancy. The ability of color and power Doppler US to demonstrate testicular perfusion aids in reaching a specific diagnosis in patients with acute scrotal pain. This review covers the anatomy of the scrotum and the scanning protocol for scrotal US, as well as detailed descriptions of disease processes and their US appearances. Newly described conditions such as intratesticular varicoceles and other benign intratesticular cystic lesions are also discussed.