Diagnostic Ultrasound - Abdomen and Pelvis

Focal Testicular Mass
– Most common testicular tumor in men older than 60
years; multiple lesions; 50% of cases bilateral
– Often large at time of diagnosis
– Commonly occurs in association with disseminated
disease
– Ill-defined, predominantly hypoechoic lesions
– Increased vascularity on color Doppler
– Involvement of epididymis and spermatic cord is
common
– Hemorrhage or necrosis is rare
○ Leukemia
– Most often seen in children
– Testis is often the 1st site of extramedullary relapse
– Diffuse testicular infiltration appears diffusely
hypoechoic with increased vascularity; may be
indistinguishable from orchitis on ultrasound
□ Clinical correlation with signs of inflammation may
help identify orchitis
○ Metastases are rare
– Most common primaries include prostate, lung, and GI
tract
○ Testis is frequent site of recurrence in male patients with
lymphoma and acute leukemia
• Gonadal Stromal Tumor
○ Bilateral in 3%
– < 3 cm usually benign
– > 5 cm usually malignant
○ Leydig cell tumor
– Small solid hypoechoic testicular mass
– In larger tumor, hemorrhage or necrosis leads to
heterogeneous echo pattern
○ Sertoli cell tumor
– Small hypoechoic mass
– Solid and cystic components
– Punctate calcification may be present; large calcified
mass in calcifying Sertoli cell tumor
– Hemorrhage may lead to heterogeneity
○ Indistinguishable from other testicular tumors by
ultrasound findings
• Testicular Epidermoid Cyst
○ Cystic cavity lined by stratified squamous epithelium
○ Onion skin appearance on ultrasound due to alternating
layers of keratin and desquamated squamous cells
○ May have peripheral calcified rim
• Testicular Adrenal Rests
○ Described in patients with congenital adrenal hyperplasia
○ May be associated with impaired spermatogenesis
○ Usually bilateral hypoechoic lesions; typically located at
the mediastinum testis
○ If left untreated may lead to fibrosis and testicular
destruction
• Testicular Sarcoid
○ Usually bilateral involvement of epididymii and testes
○ Hypoechoic nodule(s)
○ Associated chest findings on radiograph or CT may be
helpful clue
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. Piton N et al: Focal non granulomatous orchitis in a patient with Crohn's
disease. Diagn Pathol. 10(1):39, 2015
3. Rajkanna J et al: Large testicular adrenal rest tumours in a patient with
congenital adrenal hyperplasia. Endocrinol Diabetes Metab Case Rep.
2015:140080, 2015
4. Thompson JP et al: Identify Before Orchiectomy: Segmental Testicular
Infarct. Ultrasound Q. ePub, 2015
5. 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
6. Gaur S et al: Spontaneous intratesticular hemorrhage: two case descriptions
and brief review of the literature. J Ultrasound Med. 30(1):101-4, 2011
7. Loberant N et al: Striated appearance of the testes. Ultrasound Q. 26(1):37-
44, 2010
8. Bhatt S et al: Role of US in testicular and scrotal trauma. Radiographics.
28(6):1617-29, 2008
9. Bhatt S et al: Sonography of benign intrascrotal lesions. Ultrasound Q.
22(2):121-36, 2006
10. Dogra V et al: Acute painful scrotum. Radiol Clin North Am. 42 (2): 349-63,
2004
11. Mazzu D et al: Lymphoma and leukemia involving the testicles: findings on
gray-scale and color Doppler sonography. AJR Am J Roentgenol. 164(3):645-
7, 1995
Differential Diagnoses: Scrotum
Testicular Carcinoma
Orchitis (Epididymoorchitis)
(Left) Sagittal color Doppler
ultrasound of the right testis
in a 30-year-old man shows a
focal well-defined hypoechoic
mass with increased
vascularity. Associated
testicular microliths ſt are
noted. Pathologically, this was
confirmed to be a seminoma.
(Right) Sagittal color Doppler
ultrasound of right testis in a
22-year-old man with acute
right scrotum shows a focal
hypervascular hypoechoic
mass . Associated overlying
skin thickening and
complex hydrocele st are
seen. Patient was found to
have focal orchitis.
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