Scrotal Doppler

• Anatomy
• Indications
• Normal findings
• Pathological conditions
Anatomy
 Indications
• Undescended testis
• Infection : epididymitis , orchitis , epididymorchitis
• Trauma : contusion , rupture ,hematoma
• Torsion
• Intratesticular masses
Normal Findings
Tubular Ectasia Of Rete Testis
 Pathological conditions
• A-UNDESCENDED TESITS

• Examine Inguinal canal and scrotal neck

• Complicaitons :
1. hypospermic patient and infertility
2. Increase risk of malignancy
3. Testicular torsion
 2- Epididymo-orchitis
• The most common cause of scrotal pain in adult
• Sonographic findings include :
• Hypoechoic enlarged epididymis and testis
• Heterogenous texture of testis
• Increased flow
• Reactive hydrocele or hematocele
• Scrotal wall thickening
• Epididymis may be affected alone
 3-TRAUMA
• Sonographic features of trauma
1. Scrotal wall thickening
2. Haematocele which appear echogenic then later hypoechoic in
texture
• In case of rupture :
1. Discontinuity of tunica albuginea
2. Irregular hetergeoous testicular margins
• Incase of contusion : hypoechoic lesion with no vascularity inside that
decrease on follow up
4- TESTICULAR TORSION
• Spertmaic cord torsion is surgical emergency
• If surgery performed within 5 to 6 hours of onset of pain, 80 to 100 %
of testis can be salvaged
• Between 6 an 12 hours ,salvage rate is 70 %
• After 12 hours only 20 % will be saved
• Sonographic findings depends on the time :
1. Up to 6 hours ,scrotal contents may appear normal with no flow on
color mode
2. After 6 hours ,swollen and hypoechoic testis
3. After 24 hours , heterogeneous texture
 5- Hydrocele , Pyocele And Haematocele
• Hydrocele is the most common cause of painless scrotal swelling
 6-VARICOCELE
• Abnormal dilatation of testicular veins
• 78 % more on left side and from 15 to 25 % bilateral
 7-SCROTAL MASSES
• Most intratesticular lesions are malignant
• Most extratesticular lesions are benign
• Solid or cystic
Seminoma
Seminoma
 8- CYSTS
• Common in men
• Incidental benign findings
• May be intratesticular ,tunical, epididymal head
 9- MICROLITHIASIS
• May be uni or bilateral
• With no acoustic shadowing
• 5 % with infertility
• 7 % with cryptorchidism
• 44 % with tumors so annual follow up is recommended
10- Hernia
11- ENCYSTED HYDROCELE OF SPERMATIC
CORD
 Report Of Normal Scrotal Examination
Scrotal Ultrasonography Revealed:-

• Both testes are of normal size and echo-pattern with no focal lesions.
• No dilated pampiniform plexus of veins or reflux on Valsalva
manoeuvre.
• No hydrocele formation.
Impression:-
• Normal study.
 REPORT OF VARICOCELE
• Scrotal Ultrasonography Revealed:-

• Both testes are of normal size and echo-pattern with no focal lesions.
• No dilated pampiniform plexus of veins or reflux on Valsalva manoeuvr on
right side
• Dilated pampiniform plexuses on left side reaching 4 mm in diameter with
reflux on valsalva
• No hydrocele formation.
Impression:-
• Left refluxing varicocele as described above .