SCROTUM ANATOMY

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Epidiymis
Lobulated structure which is usually located posteriorly and laterally to the
testis and consists of a head, body and tail.
Connected to the testis by the mediastinum testis and thin connective
tissue structures at the head and tail.
The head of the epididymis is the largest portion of the epididymis which
comprises of ductules from the rete testis converging to form the ductus
epididymis.
The epididymal head is superior to the testis with the tail located at the
lower pole of the testis.
The tail of the epididymis is continuous with the vas deferens.
The epididymis is involved in the maturation, transport and storage of
sperm.

This ultrasound image shows the head of the epididymis (white arrow) next to the testis.
Compared to the normal testicle the epididymis is normally isoechoic or slightly more
echogenic. Notice the coarse composition of the epididymis relative to the echotexture of the
testicle.

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Testis
Testes are paired oval shaped glands approximately 4 to 5.5 cm long.
Testis is surrounded by a fibrous capsule, the tunica albuginea.
Multiple thin septa are formed from the inner aspect of the tunica albuginea
and converge to form the mediastinum.
as the septa are directed into the testis they form lobules (approximately
250)
Each lobule contains coiled seminiferous tubules, these course towards the
center of the testis where they form larger ducts called the tubuli recti, which
enter the mediastinum testis forming a network of channels called the rete
testis.
These channels terminate into ductules on the superior surface of the
mediastinum and carry sperm from the testis to the epididymis.
The mediastinum testis is the invagination of the tunica albuginea and rete
testis.
o The rete testis is the anastomosis of a network of tubules in the
mediastinum that transport sperm from the seminiferous tubules to the
vas deferens.
o The mediastinum also contains two branches of the testicular artery,
veins and lymphatics.

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This ultrasound image through the middle portion of a testis demonstrates the homogenous
appearance of the testis. Note the thin hypoechoic ring of fibrous tissue surrounding the testis giving it
an encapsulated appearance. This ring is the tunica vaginalis (white arrow), which contains a small
amount of fluid between its layers (visceral and parietal tunica).

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Spermatic cord
The spermatic cord consists of the:
Vas deferens,
Pampiniform plexus,
Testicular, differential and cremasteric arteries,
Lymphatics and nerves of the testis.

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Scrotum
The superficial fascia and dartos muscle of the scrotum forms an incomplete
scrotal septum which divides the scrotum into two halves.
Appendix of the testis and epididymis are embryological remnants of the
paramesonephric and mesonephric ducts respectively. They are occasionally
seen as separate structures when a hydrocele is present.

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Arterial Supply

The paired testicular arteries arise from the abdominal aorta and descend
through the inguinal canal with the spermatic cord.
The testicular artery divides to supply the surface of the testis by penetrating
the tunica albuginea.
Capsular arteries course through the testis towards the mediastinum. A
transmedial artery which enters the mediastinum to supply the testis is a
common variant the cremasterica artery arises from the inferior epigastric
artery and supplies the scrotal wall and extra testicular structures
The defential artery arises from the inferior vesical artery and supplies the tail
of the epididymis and vas deferens.

Venous Supply
The veins leave the posterior testis and converge to join the vein from the
epididymis to form the pampiniform plexus which passes as part of the
spermatic cord through the inguinal canal.
The pampiniform plexus drains into the testicular veins, the right testicular
vein drains into the inferior vena cava and the left testicular vein drains into
the left renal vein.
Lymphatics
The lymphatic drainage follows the course of the testicular artery to the paraaortic lymph nodes.
The scrotal sac lymphatic drainage is to the inguinal lymph nodes.

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SCANNING TECHNIQUE

careful explanation and informed consent must be given

a chaperone maybe required
A full clinical history must be taken and overview of any previous
examinations/test results.
The examination room should be warm and the door closed with a do not
disturb sign.
The patient lies supine on the examination table with a towel over the thighs
to support the scrotal sac when required. The penis should be placed, by the
patient, on the anterior abdominal wall and covered with a towel.
Warm gel is applied to the scrotal sac.
A high frequency linear array transducer should be used. Usually 14 to
10MHz.
The scrotal sac is carefully examined to include all contents using colour
Doppler when required.
longitudinal and transverse scans of both testes comparing the size, texture,
vascularity as well as the scrotal sac fluid and the head, body and tail of the
epididymis.
The valsalva manovere should be performed when assessing a possible
varicocele, occasionally an erect position maybe required.
Attention must be applied to any specific area of pain or lumps felt, these
maybe palpated by the sonographer or patient.
Normal Ultrasonic measurements
Testes
(Varies with age)
longitudinal
transverse
anteroposterior diameter
Epididymis
Head
Body

30 50mm
20 30 mm
30mm

10 12 mm
Diameter
<4mm AP