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Compression Technique in Scrotal Ultrasound
Purpose:
The compression technique is used during a scrotal ultrasound to:
➤ Differentiate inguinal hernia from hydrocele or other scrotal pathologies.
➤ Assess vascular flow in suspected varicocele or scrotal hematomas.
➤ Evaluate for scrotal masses to determine if they are compressible (fluid-filled) or non-compressible (solid).
Procedure:
Apply Gentle Compression with the Transducer
- Place the linear probe (7–15 MHz) over the scrotum.
- Apply gradual but firm pressure while observing changes in the underlying structures.
Observe the Response:
- Inguinal Hernia:
- If bowel loops or omental fat move into and out of the scrotum during compression, a hernia is confirmed.
- Color Doppler can assess vascular flow to check for strangulation.
- Varicocele:
- If the dilated veins of the pampiniform plexus collapse with compression but refill upon release, a varicocele is confirmed.
- Hydrocele:
- Fluid collections do not compress but may shift with pressure.
- Hematoma/Abscess:
- Typically non-compressible and may show internal debris or septations.
- Cysts vs. Solid Masses:
- Cysts may slightly deform but remain anechoic.
- Solid tumors will be firm and non-compressible.
- Inguinal Hernia:
Interpretation of Findings:
| Condition | Compressible? | Additional Features |
|---|---|---|
| Inguinal Hernia | Yes (bowel moves) | Bowel peristalsis, color Doppler for strangulation |
| Varicocele | Yes (veins collapse) | Veins refill after release, confirm with Valsalva maneuver |
| Hydrocele | No | Anechoic fluid collection, no vascularity |
| Hematoma | No | Complex echogenicity, may show septations |
| Abscess | No | Hypoechoic, possible internal debris |
| Cyst | Slightly | Anechoic, well-defined |
| Tumor (Solid Mass) | No | Hypoechoic, irregular, increased vascularity |
Clinical Use Cases:
➤ Confirming varicocele by distinguishing dilated veins from other structures.
➤ Assessing inguinal hernia to determine reducibility and risk of strangulation.
➤ Differentiating cystic vs. solid masses in the scrotum.
➤ Evaluating post-traumatic hematoma to check for liquefaction or resolution.
