Scrotal Ultrasound

Definition

Scrotal ultrasound is an imaging technique used for the diagnosis of suspected abnormalities of the scrotum and testes. It uses harmless, high-frequency sound waves to form an image. The sound waves are reflected by scrotal tissue to form a picture of internal structures. It is not invasive and involves no radiation.

Purpose

Ultrasound of the scrotum is the primary imaging method used to evaluate disorders of the testicles and surrounding tissues. It is used when a man has acute pain in the scrotum. Some of the medical problems for which the use of scrotal ultrasound is valuable include an absent or undescended testicle, inflammation of the testicle or associated structures, testicular torsion, a fluid collection (hydrocele), abnormal blood vessels (varicocele), or a mass (lump or tumor).

A sudden onset of pain in the scrotum is considered a serious problem. Delay in diagnosis and treatment can lead to loss of function. Epididymitis is the most common cause of this type of pain. Epididymitis is an inflammation of the epididymis, a tubular structure that transports sperm from the testes. It is most often caused by bacterial infection, but may occur after injury, or arise from an unknown cause. Epididymitis is treatable with antibiotics, which usually resolves pain quickly and ice to reduce swelling. Left untreated, this condition can lead to abscess formation or loss of blood supply to the testicle. The latter condition can cause testicular loss.

Testicular torsion is the twisting of the spermatic cord that containing the blood vessels that supply the testicles. It is caused by abnormally loose attachments of tissues that are formed during fetal development. Torsion can be complete, incomplete, or intermittent. Spontaneous detorsion, or untwisting, can occur, making diagnosis difficult. Testicular torsion arises most commonly during adolescence, and is acutely painful. Scrotal ultrasound is used to distinguish this condition from inflammatory problems, such as epididymitis. Testicular torsion is a surgical emergency; it should be operated on as soon as possible to avoid permanent damage to the testes.

A scrotal sac with an absent testicle may be the result of a congenital anomaly (an abnormality present at birth), where a testicle fails to develop. More often, it is due to an undescended testicle. In the fetus, the testicles normally develop just outside the abdomen and descend into the scrotum during the seventh month. Approximately 3% of full term baby boys have undescended testicles. It is important to distinguish between an undescended testicle and an absent testicle, as an undescended testicle has a very high probability of developing cancer if left untreated.

Ultrasound can be used to locate and evaluate masses in the scrotum. Most masses within the testicle are malignant or cancerous, and most outside the testicle are benign. Primary cancer of the testicles is the most common malignancy in men between the ages of 20 and 35. Fluid collections and abnormalities of the blood vessels in the scrotum may appear to the physician as masses and need evaluation by ultrasound. A hydrocele, the most common cause of painless scrotal swelling, is a collection of fluid between two layers of tissue surrounding the testicle. An abnormal enlargement of the veins which drain the testicles is called a varicocele. It can cause discomfort and swelling, which can be examined by touch (palpated). Varicocele is a common cause of male infertility, and is more common on the left testicle.

Precautions

Clear scrotal ultrasound images are difficult to obtain if a person is unable to remain still. Other than cleaning the surface of the skin upon which a transducer will be placed, there are no special precautions that are associated with ultrasonography.

Description

A transducer (an electronic imaging device) is used to both generate and receive acoustic images. It is placed against the skin over the structure to be examined. The transducer is moved over the area creating images from reflected sound waves, which appear on a monitor screen. There is no discomfort from the study itself. However, if the scrotum is very tender, even the slight pressure involved may be painful.

Preparation

The patient lies on his back on an examining table. The technologist will usually take a history of the problem, then gently palpate the scrotum. A rolled towel is placed between the patient's legs to support the scrotum. The penis is lifted up onto the abdomen and covered. A gel that enhances sound transmission is applied directly on the scrotum. The technologist then gently places a transducer (an electronic imaging device) against the skin.

Aftercare

The transducing gel is removed with soap and water. Any underlying medical condition is treated. There is no aftercare for the scrotal ultrasound examination.

Complications

There are no complications associated with ultrasonography.

Results

A normal study reveals testicles of normal size and shape, with no masses or abnormalities.

An abnormal result of an ultrasound of the scrotum may reveal an absent or undescended testicle, an inflammation problem, testicular torsion, a fluid collection, abnormal blood vessels, or a mass.

Health care team roles

A family physician, pediatrician, urologist, or emergency room doctor usually orders a scrotal ultrasound examination. An ultrasonographer or radiologist performs the examination. A radiologist interprets the images obtained.

KEY TERMS

Epididymis— A tubular structure that transports sperm from the testes to the vas defens, which transports it to the prostate gland.

Hydrocele— A collection of fluid between two layers of tissue surrounding the testicle; the most common cause of painless scrotal swelling.

Scrotum— The structure of skin that surrounds and protects the testicles.

Testicular torsion— A twisting of the spermatic cord that containing the blood vessels supplying the testicles.

Varicocele— An abnormal enlargement of the veins which drain the testicles.

Resources

BOOKS

Allan, Paul L., Paul A. Dubbins, Myron A. Pozniak, and W. N. McDicken. Clinical Doppler Ultrasound. London: Churchill Livingstone, 2000.

Evans, David H., and W. N. McDicken. Doppler Ultrasound: Physics, Instrumental, and Clinical Applications, 2nd ed. New York: Wiley, 2000.

Gill, Katheryn A. Abdominal Ultrasound: A Practitioner's Guide. Philadelphia: Saunders, 2001.

Hofer, Matthias, and Stanley Platypus. Teaching Manual of Color Duplex Sonography. New York: Thieme Medical Publishers, 2001.

Kurjak, Asim, and Sanja Jupesic. Clinical Application of 3D Sonography. Pearl River, NY: Parthenon Publishing Group, 2000.

Papadakis, Emmanuel. Ultrasonic Instruments and Devices: Reference for Modern Instrumentation, Techniques, and Technology. New York: Academic Press, 2000.

PERIODICALS

Frauscher F., A. Klauser, A. Stenzl, G. Helweg, B. Amort, and D. zur Nedden. "Ultrasound findings in the scrotum of extreme mountain bikers." Radiology 219, no. 2 (2001): 427-431.

Gordon, S. J., U. Otite, P. Maheshkumar, P. Cannon, and V. H. Nargund. "The use of scrotal ultrasonography in male infertility." British Journal of Ultrasonography International 87, no. 4 (2001): 417-418.

Micallef, M., I. Ahmad, N. Ramesh, M. Hurley, and D. McInerney. "Ultrasound features of blunt testicular injury." Injury 32, no. 1 (2001): 23-26.

Pavlica, P., and L. Barozzi. "Imaging of the acute scrotum." European Radiology 11, no. 2 (2001): 220-228.

Simon, S. D., R. D. Lee, and J. P. Mulhall. "Should all infertile males undergo urologic evaluation before assisted reproductive technologies? Two cases of testicular cancer presenting with infertility." Fertility and Sterility 75, no. 6 (2001): 1226-1227.

Varsamidis, K., E. Varsamidou, and G. Mavropoulos. "Doppler ultrasonography in testicular tumors presenting with acute scrotal pain." Acta Radiology 42, no. 2 (2001): 230-233.

ORGANIZATIONS

American College of Radiology. 1891 Preston White Drive, Reston, VA 20191. (703) 648-8900. Fax: (703) 262-9319. 〈http://www.acr.org〉. [email protected].

American Foundation for Urologic Disease. 1128 North Charles Street, Baltimore, MD 21201. (800) 242-2383 or (410) 468-1800. 〈http://www.afud.org〉. [email protected].

American Infertility Association. 666 Fifth Avenue, Suite 278, New York, NY 10103. (718) 621-5083. 〈http://www.americaninfertility.org/〉. [email protected].

American Institute of Ultrasound In Medicine. 14750 Sweitzer Lane, Suite 100, Laurel, Maryland 20707-5906. (301) 498-4100 or (800) 638-5352. Fax: (301) 498-4450. 〈http://www.aium.org/〉.

American Osteopathic College of Radiology. 119 East Second St ¦ Milan, MO 63556. (660) 265-4011. Fax: (660) 265-3494. 〈http://www.aocr.org/〉. [email protected].

American Registry of Diagnostic Medical Sonographers. 600 Jefferson Plaza, Suite 360, Rockville, Maryland 20852-1150. (301) 738-8401 or (800) 541-9754. Fax: (301) 738-0312/0313. 〈http://www.ardms.org〉.

American Urological Association. 1120 North Charles Street, Baltimore, MD 21201. (410) 727-1100. Fax: (410) 223-4370. 〈http://www.auanet.org/index_hi.cfm〉. [email protected].

Society of Radiologists in Ultrasound. 44211 Slatestone Court, Leesburg, VA 20176-5109. (703) 858-9210. Fax: (703) 729-4839. 〈http://www.sru.org/〉. [email protected].

OTHER

Medical College of Georgia. 〈http://www.mcghealthcare.org/radiology/ultra/ultra.htm〉.

Scrotal Ultrasound pictures. 〈http://www.gemedicalsystems.com/rad/us/products/log_700pro/msu302.html〉 and 〈http://www.gemedicalsystems.com/rad/us/products/log_700pro/msu301.html〉 and 〈http://ultrasound.ucsf.edu/scrotal.html〉 and 〈http://www.drgdiaz.com/pat/scrotal_hernia.shtml〉.

University of Iowa. 〈http://www.vh.org/Providers/Lectures/IROCH/ScrotalUS/Captions/UStwo34.html〉.

University of Maryland College of Medicine. 〈http://www.umm.edu/radiology/ultra.htm〉.

University of Michigan College of Medicine. 〈http://www.med.umich.edu/1libr/tests/testu08.htm〉.