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Contants
- Introduction
- Methods of scrotal ultrasound
- Steps before performing scrotal sonography
- Scrotal pathology
- Normal v/s Abnormal scrotal findings
- Scrotal US sample reports
- Routine case study
Introduction to Scrotal Ultrasound
Scrotal ultrasound is the primary imaging modality for evaluating the scrotum, including
the testes, epididymis, and spermatic cord structures. Normal scrotal ultrasound
demonstrates the following features:
Indications for Scrotal Ultrasound
о Acute scrotal pain: Suspected testicular torsion, epididymo-orchitis, or trauma.
о Scrotal swelling/masses: Differentiation between solid and cystic lesions (hydrocele, varicocele, tumors).
о Infertility evaluation: Assessment of varicocele and testicular atrophy.
о Cryptorchidism: Localization of undescended testes.
о Postoperative assessment: Evaluation after surgery for hernia, hydrocele, or orchiectomy
Advantages of Scrotal Ultrasound
о High-resolution imaging of superficial structures.
Advantages of Scrotal Ultrasound
о High-resolution imaging of superficial structures.
о Real-time assessment of scrotal contents.
о Doppler capability to assess vascularity in conditions like torsion or varicocele.
о No radiation exposure, making it safe for all patients
о Scrotal ultrasound plays a crucial role in early detection and diagnosis, guiding further management and treatment decisions effectively.
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➥Normal v/s Abnormal scrotal findings
➥Routine case study
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Methods of scrotal ultrasound
Scrotal ultrasound is a non-invasive imaging technique used to evaluate the scrotum, including the testes, epididymis, and surrounding structures. The key methods used in scrotal ultrasound include:1. Patient Preparation
- The patient is placed in a supine position.
- A towel or scrotal support may be used to elevate the scrotum for better visualization.
- Warm ultrasound gel is applied to avoid discomfort and improve contact.
- The patient may be asked to perform the Valsalva maneuver (bearing down) to assess venous flow, particularly in cases of suspected varicocele
2. Imaging Techniques
o Uses high-frequency transducers (7–15 MHz) for detailed imaging.o Assesses testicular size, shape, echotexture, and presence of masses, cysts, or fluid collections (e.g., hydrocele).
➥Grayscale Evaluation and Measuring Parameters
➥Scanning Protocol
➥Grayscale ultrasound based findings
o Spectral Doppler: Measures the velocity and direction of blood flow.
o Used to evaluate testicular torsion (reduced or absent flow) and epididymo-orchitis (increased flow due to inflammation).
o More sensitive than color Doppler for detecting low-velocity blood flow.
o Helps in diagnosing subtle vascular abnormalities or early torsion.
o Measures tissue stiffness to differentiate benign vs. malignant testicular lesions.
o Uses contrast agents to assess tumor vascularity.
o Helpful in differentiating infarcts, abscesses, and neoplasms.
➥Scanning Protocol
➥Grayscale ultrasound based findings
ii. Doppler Ultrasound
o Color Doppler: Detects and assesses blood flow within the testes and epididymis.o Spectral Doppler: Measures the velocity and direction of blood flow.
o Used to evaluate testicular torsion (reduced or absent flow) and epididymo-orchitis (increased flow due to inflammation).
➥Comprehensive Guide for scrotal doppler ultrasound:
1. Introduction
Scrotal Doppler ultrasound is a non-invasive imaging technique used to evaluate the testes, epididymis, spermatic cord, and scrotal vessels. It is particularly useful for assessing vascular flow abnormalities, acute scrotal pain, swelling, infertility, and testicular masses.
2. Indications for Scrotal Doppler Ultrasound
o Acute scrotal pain (e.g., testicular torsion vs. epididymitis)
o Swelling or scrotal masses (e.g., hydrocele, tumor)
o Evaluation of infertility (e.g., varicocele)
o Scrotal trauma (e.g., hematoma, testicular rupture)
o Suspected testicular ischemia or infarction
o Follow-up after scrotal surgery (e.g., varicocelectomy)
o Helps in diagnosing subtle vascular abnormalities or early torsion.
o Measures tissue stiffness to differentiate benign vs. malignant testicular lesions.
o Helpful in differentiating infarcts, abscesses, and neoplasms.
3. Scanning Protocol
o Bilateral evaluation: Both testes are scanned in longitudinal and transverse planes.o Comparison with the contralateral testis is crucial for detecting abnormalities.
o Examination of the epididymis, spermatic cord, and scrotal wall for inflammation, masses, or varicocele.
4. Special Techniques
o Valsalva Maneuver: Used in Doppler mode to diagnose varicocele by assessing venous dilation.o Cold Room Test or Ice Pack Test: Sometimes applied in suspected intermittent torsion to observe changes in blood flow.
o Compression Technique: Helps evaluate venous reflux in varicocele assessment.
