Diagnostic Ultrasound - Abdomen and Pelvis

Testicular Calcifications
Differential Diagnoses: Scrotum
DIFFERENTIAL DIAGNOSIS
Common
• Testicular Microlithiasis
• Nonseminomatous Germ Cell Tumor
• Sertoli Cell Tumor
Less Common
• Scrotal Trauma
• Scrotal Pearl
• Epidermoid Cyst
• Scrotal Abscess or Epididymoorchitis
• Tunica Albuginea Cyst
ESSENTIAL INFORMATION
Key Differential Diagnosis Issues
• Correlation between clinical and sonographic features
essential
○ Incidental finding: Testicular microlithiasis, scrotal pearl
○ History of pain: Abscess, chronic infections, tumors
○ Mass with intrinsic calcification: Testicular tumors,
epidermoid cyst
○ Associated with trauma: Testicular hematoma,
hematocele
Helpful Clues for Common Diagnoses
• Testicular Microlithiasis
○ Multiple small (2-3 mm), discrete, nonshadowing,
echogenic intratesticular foci
○ Unilateral or bilateral involvement
○ Concurrent germ cell tumor in up to 40%
• Nonseminomatous Germ Cell Tumor
○ Complex solid-cystic testicular mass
○ Heterogeneous echogenic foci due to calcification ±
fibrosis, along with retroperitoneal lymphadenopathy
can be seen with burnt out testicular tumor
○ Calcifications more common in tumors that contain
teratomatous components
• Sertoli Cell Tumor
○ Small, hypoechoic, solid-cystic mass
○ Punctate calcification may be present
○ Occasionally, tumoral calcification may form large
calcified mass, known as large calcifying Sertoli cell
tumor
Helpful Clues for Less Common Diagnoses
• Scrotal Trauma
○ Chronic hematocele
– Complex echogenic fluid
– If chronic, appears as heterogeneous echogenic mass,
± calcification
– No intrinsic vascularity on Doppler
• Scrotal Pearl
○ Calcification of detached testicular epididymal
appendages due to previous inflammation or torsion of
appendages
○ Solitary, discrete, echogenic focus in tunica vaginalis
• Epidermoid Cyst
○ Lamellated appearance on ultrasound
○ May have peripheral calcified rim
• Scrotal Abscess or Epididymoorchitis
○ Tuberculous infections may produce intrascrotal
calcifications, scrotal sinuses
○ Granulomas appear as small echogenic foci, ±
calcification
• Calcified Tunica Albuginea Cyst
○ Typically located at anterosuperior aspect of testis
○ Within tunica albuginea; may cause mass effect on
testicular parenchyma if large
○ Avascular
SELECTED REFERENCES
1. Richenberg J et al: Testicular microlithiasis imaging and follow-up: guidelines
of the ESUR scrotal imaging subcommittee. Eur Radiol. 25(2):323-30, 2015
2. Alvarez DM et al: Sonographic spectrum of tunica albuginea cyst. J Clin
Imaging Sci. 1:5, 2011
3. Woodward PJ et al: From the archives of the AFIP: tumours and tumorlike
lesions of the testis:radiologic-pathologic correlation. Radiographics.
22(1):189-216, 2002
4. Taghizadeh AK et al: Calcified epidermoid cyst in the testis: an unusual
finding on ultrasound. Eur J Ultrasound. 11(3):199-200, 2000
(Left) Sagittal grayscale
ultrasound of the right testis
demonstrates multiple tiny
calcific foci consistent with
testicular microlithiasis.
(Right) Transverse grayscale
ultrasound of the right testis
demonstrates a partially
calcified heterogeneous mass
. Pathology confirmed a
mixed germ cell tumor with
75% embryonal cell, 15%
teratoma, and 10% yolk cell
components.
Testicular Microlithiasis
Nonseminomatous Germ Cell Tumor
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