Grayscale Ultrasound-Based Scrotal Findings

 Grayscale Ultrasound-Based Scrotal Findings

________________________________________________________________________

1. Testicular Abnormalities

• Testicular Torsion:
  • Initial findings: Normal grayscale appearance.
  • Late findings: Enlarged, hypoechoic testis with heterogeneous echotexture due to infarction.
  • Absence or reduction of intratesticular blood flow on Doppler.
• Orchitis/Epididymo-Orchitis:
  • Hypoechoic, enlarged testis with increased blood flow on Doppler.
  • Reactive hydrocele may be present.
• Testicular Tumors:
  • Typically hypoechoic solid intratesticular masses.
  • Heterogeneous echotexture in cases of necrosis or hemorrhage.
  • Some tumors, like seminomas, appear uniformly hypoechoic with well-defined margins.
• Testicular Abscess:
  • Complex, hypoechoic mass with irregular walls.
  • Presence of gas may produce dirty shadowing.
• Testicular Microlithiasis:
  • Multiple small echogenic foci without acoustic shadowing.
  • Can be associated with increased risk of testicular malignancy.

2. Epididymal Pathologies

• Epididymitis:
  • Enlarged, hypoechoic epididymis with increased Doppler flow.
• Spermatocele:
  • Anechoic or hypoechoic cystic structure in the epididymal head.
  • Contains low-level echoes due to sperm content.
• Epididymal Cyst:
  • Simple anechoic lesion with posterior acoustic enhancement.
• Epididymal Tumors:
  • Rare, typically hypoechoic solid masses.

3. Scrotal Wall & Tunica Abnormalities

• Hydrocele:
  • Anechoic fluid collection around the testis.
  • May contain septations in chronic cases.
• Hematocele:
  • Complex fluid collection with internal echoes due to blood.
• Pyocele:
  • Complex fluid with septations and debris due to infection.
• Scrotal Edema:
  • Thickened, hypoechoic scrotal wall.

4. Vascular Abnormalities

• Varicocele:
  • Dilated, tortuous veins of the pampiniform plexus (>2 mm).
  • Enlargement with Valsalva maneuver.
• Testicular Infarction:
  • Initially hypoechoic, progressing to heterogeneous texture.
• Scrotal Hematoma:
  • Hypoechoic or mixed echogenicity mass that may evolve over time.
• Scrotal Trauma:
  • Disruption of tunica albuginea suggests testicular rupture.

5. Paratesticular Masses

• Lipomas (most common benign extratesticular tumor):
  • Well-defined, hyperechoic lesions.
• Adenomatoid Tumor:
• Small, solid, hypoechoic mass in epididymis.

_____________________________