Diagnostic Ultrasound - Abdomen and Pelvis

Diffuse Testicular Enlargement
Differential Diagnoses: Scrotum
DIFFERENTIAL DIAGNOSIS
Common
• Orchitis
• Testicular Torsion/Infarction
• Testicular Carcinoma
• Scrotal Trauma
Less Common
• Testicular Lymphoma
• Testicular Metastases
• Testicular Cyst
ESSENTIAL INFORMATION
Key Differential Diagnosis Issues
• Diagnosis depends not on sonographic appearances alone,
but on combination of clinical and ultrasound features
Helpful Clues for Common Diagnoses
• Orchitis
○ Characterized by edema of testes contained within rigid
tunica albuginea
○ Heterogeneous parenchymal echogenicity and septal
accentuation, seen as hypoechoic bands
○ Diffuse increase in testicular parenchymal vascularity on
color Doppler ultrasound
• Testicular Torsion/Infarction
○ Acute infarction: Diffusely enlarged hypoechoic testis
○ Chronic infarction: Small, shrunken, heterogeneous testis
○ "Whirlpool" or "torsion knot" at level of spermatic cord;
dampened or absent vascularity in testis
• Testicular Carcinoma
○ Discrete hypoechoic or mixed echogenic testicular mass
± vascularity
○ Although seminomas are usually discrete hypoechoic
lesions, they may cause diffuse enlargement of involved
testis
• Scrotal Trauma
○ History of scrotal trauma
○ Focal hypoechoic area, discrete linear/irregular fracture
plane within testis, tunica albuginea rupture, hematocele
○ Abnormal testicular parenchymal echogenicity, avascular
mass; echogenicity of hematoma depends on its age
Helpful Clues for Less Common Diagnoses
• Testicular Lymphoma and Metastases
○ Multiple >> solitary lesion(s); 50% of cases bilateral
○ Metastases are rare; most common sites include
prostate, lung, and GI tract
○ Often large in size at time of diagnosis; associated with
disseminated disease
– Ill-defined, mostly hypoechoic lesions
• Testicular Cyst
○ Intratesticular cysts are usually simple cysts located near
mediastinum testis
○ Need to differentiate them from cystic neoplasms
– Search carefully for solid components and internal
vascularity
SELECTED REFERENCES
1. Coursey Moreno C et al: Testicular tumors: what radiologists need to know--
differential diagnosis, staging, and management. Radiographics. 35(2):400-
15, 2015
2. Nicola R et al: Imaging of traumatic injuries to the scrotum and penis. AJR
Am J Roentgenol. 202(6):W512-20, 2014
3. Bhatt S et al: Imaging of non-neoplastic intratesticular masses. Diagn Interv
Radiol. 2011 Mar;17(1):52-63. Epub 2010 Jun 30. Review. Erratum in: Diagn
Interv Radiol. 17(4):388, 2011
4. Loberant N et al: Striated appearance of the testes. Ultrasound Q. 26(1):37-
44, 2010
5. Bhatt S et al: Role of US in testicular and scrotal trauma. Radiographics.
28(6):1617-29, 2008
6. Dogra VS et al: Torsion and beyond: new twists in spectral Doppler
evaluation of the scrotum. J Ultrasound Med. 23(8):1077-85, 2004
7. Dogra V et al: Acute painful scrotum. Radiol Clin North Am. 42 (2): 349-63,
2004
8. Dogra VS et al: Sonography of the scrotum. Radiology. 227(1):18-36, 2003
9. Dogra VS et al: Benign intratesticular cystic lesions: US features.
Radiographics. 21 Spec No:S273-81, 2001
10. Subramanyam BR et al: Diffuse testicular disease: sonographic features and
significance. AJR Am J Roentgenol. 145(6):1221-4, 1985
(Left) Sagittal grayscale US of
the left testis demonstrates an
enlarged heterogeneous testis
with surrounding pyocele
st and overlying skin
thickening , suggestive of
acute orchitis. (Right)
Transverse color Doppler US of
the left testis demonstrates an
enlarged, heterogeneous
testis with a striated
pattern and increased
vascularity suggestive of acute
orchitis.
Orchitis
Orchitis
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