Doppler Findings in Scrotal Pathologies

 

Doppler Findings in Scrotal Pathologies

A. Testicular Torsion (Emergency)

Pathophysiology: Twisting of the spermatic cord → ischemia

• Acute (<6 hours)
  • Absent or reduced arterial flow
  • High-resistance waveform (RI > 0.7)
  • Decreased or reversed diastolic flow
• Late (>12 hours, complete torsion)
  • No detectable blood flow
  • Enlarged, hypoechoic testis

B. Epididymitis & Orchitis

Pathophysiology: Inflammation → hyperemia

• Increased blood flow (Hyperemia)
• Resistive Index (RI) < 0.5
• Increased Peak Systolic Velocity (PSV > 15 cm/s)
• Thickened epididymis, scrotal wall edema

C. Varicocele

Pathophysiology: Dilated veins → venous reflux

• Venous diameter >3 mm at rest
• Increased venous size with Valsalva maneuver (>4 mm)
• Spectral Doppler: Reversal of flow (reflux) lasting >1 second

D. Testicular Tumors

Pathophysiology: Neovascularization → hypervascular mass

• Increased vascularity (suspicious for malignancy)
• Low RI (<0.5)
• Irregular blood flow patterns

E. Scrotal Trauma & Hematoma

Pathophysiology: Disrupted blood supply → ischemia, rupture

• Hematomas appear as avascular hypoechoic masses
• Testicular rupture: Disrupted tunica albuginea, reduced blood flow