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TSILI AC, TSAMPOULAS C, GIANNAKIS D, PAPASTEFANAKI M, TSIRIOPOULOS I, SOFIKITIS N, EFREMIDIS SC. Tuberculous epididymo-orchitis: MRI findings. Br J Radiol 2008; 81:e166-9. [DOI: 10.1259/bjr/16348966] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
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304
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Hassan HC, Cullen IM, Casey RG, Rogers E. Gynaecomastia: an endocrine manifestation of testicular cancer. Andrologia 2008; 40:152-7. [DOI: 10.1111/j.1439-0272.2007.00815.x] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
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305
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306
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Bonkat G, Ruszat R, Forster T, Wyler S, Dogra VS, Bachmann A. [Benign space-occupying cysts in the testis. An overview]. Urologe A 2008; 46:1697-703. [PMID: 17928986 DOI: 10.1007/s00120-007-1555-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Testicular cysts are increasingly diagnosed in the course of scrotal ultrasound examination. Among other things this is due to the general availability of modern high-resolution ultrasound devices. Benign and malignant diseases with testicular cyst formation need to be differentiated by differential diagnosis and by their aetiology. Benign diseases with cystic space-occupying lesions of the testicle are tubular ectasia of the rete testis, cystic dysplasia, epidermoid cysts, simple intraparenchymatous testicular cysts and cysts of the tunica albuginea. Testicular dermoid cyst was long misleadingly regarded as potentially malignant, but is now classified as benign. On diagnosis of a benign lesion of the testis an organ-conserving surgical therapy or an observational watch-and-wait strategy can be recommended in most cases.
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Affiliation(s)
- G Bonkat
- Urologische Klinik, Universitätsspital Basel, Spitalstrasse 21, Basel, Switzerland
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307
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308
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Elwagdy S, Razmy S, Ghoneim S, Elhakim S. Diagnostic performance of three-dimensional ultrasound extended imaging at scrotal mass lesions. Int J Urol 2008; 14:1025-33. [PMID: 17956531 DOI: 10.1111/j.1442-2042.2007.01881.x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
OBJECTIVES High resolution two-dimensional ultrasound (2D US) difficulty in evaluation of some scrotal mass lesions is not frequent. The aim of the present study was to prospectively evaluate the diagnostic performance of three-dimensional ultrasound extended imaging (3D XI) in characterization of those lesions. METHODS The study protocol had the approval of the University's review board all participants' informed consents were obtained. The study included 28 selected patients (12 testicular and 16 para-testicular mass lesions) examined by 2D US and 3D XI applications including computed multi-slice view (MSV) and multi-resolution enhanced images (XI MR). Results were correlated with histopathological findings. RESULTS Two-dimensional ultrasound did not adequately characterize 28 patients out of 329 (8.5%). 3D XI interrogation was an easy procedure and distinctive of the pathological findings in 27 patients out of 28 (96.4%). The performance of XI MR with respect to characterization provided additional diagnostic information over MSV. CONCLUSIONS The performance of 3D XI with respect to testicular mass characterization proved better than static 2D US. Subsequently, the results of this study suggest that the routine use of 2D US in diagnosis of scrotal mass lesions should preferably be upgraded to 3D XI methods.
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Affiliation(s)
- Salah Elwagdy
- Department of Radiology, Azhar University Hospital, 133 Shubra Street, Shubra, Cairo, Egypt.
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309
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Onur MR, Firdolas F, Onur R, Kocakoc E, Akpolat N, Orhan I. Scrotal ultrasonography: should it be used in routine evaluation of infertile men? Andrologia 2008; 40:58-61. [DOI: 10.1111/j.1439-0272.2008.00812.x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
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310
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Sista AK, Filly RA. Color Doppler sonography in evaluation of spermatoceles: the "falling snow" sign. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2008; 27:141-143. [PMID: 18096740 DOI: 10.7863/jum.2008.27.1.141] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/25/2023]
Abstract
OBJECTIVE Doppler sonography is not commonly used in evaluation of cystic lesions with internal echoes. Here we report the use of the mechanical properties of color Doppler sonography to further characterize 3 spermatoceles. METHODS Three patients who came to University of California San Francisco Imaging Center with painless unilateral scrotal enlargement were evaluated with sonography and were found to have large spermatoceles. Color Doppler sonography was applied to these spermatoceles, and digital video clips were obtained as the color beam was instituted. RESULTS When color Doppler sonography was applied to each spermatocele, the internal echoes moved away from the transducer, resulting in an appearance similar to falling snow. CONCLUSIONS The "falling snow" sign can be used to enhance the diagnosis of a spermatocele as well as to evaluate a superficial cystic lesion with echogenic fluid and internal microdebris that is difficult to distinguish from a solid mass.
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Affiliation(s)
- Akhilesh K Sista
- Department of Radiology, University of California, San Francisco, CA 94143-0628, USA
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311
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Abstract
We present the case of a 47-year-old man with testicular tuberculosis without epididymal involvement that simulated neoplasm on sonography. The patient also had evidence of contralateral spermatic cord involvement. The diagnosis was made following transinguinal intrascrotal exploration and excisional biopsy of the left spermatic cord mass and right transinguinal radical orchiectomy. Histopathology showed caseating granulomatous inflammation, with positive cultures for Mycobacterium tuberculosis and the patient received antituberculous treatment with satisfactory recovery.
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312
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Abstract
OBJECTIVE To sonographically investigate whether mountain bikers have a higher prevalence of scrotal abnormalities compared with on-road cyclists. DESIGN We studied 85 male mountain bikers (mean age: 25 years; range 17-45 years) and 50 male on-road cyclists (mean age: 23 years, range 15-46 years) with regard to scrotal findings on ultrasound (US). SETTING Medical University Innsbruck, Austria. PARTICIPANTS Only males who gave a history of extensive mountain biking or on-road bicycling (2 hours or more per day on 6 days a week with a covered distance of more than 5,000 km/year) were entered in our study. INTERVENTIONS In addition to clinical evaluation, a standard ultrasonographic examination of the scrotum was performed using a linear array transducer operating at a frequency of 8.0 MHz (Acuson Sequoia 512). MAIN OUTCOME MEASUREMENTS The sonographic findings obtained in mountain bikers were compared with those obtained in on-road cyclists. RESULTS Eighty of 85 mountain bikers (94%) and 24 of 50 on-road cyclists (48%) presented with abnormal findings on scrotal US. Abnormal US findings in mountain bikers included scrotoliths in 69 bikers (81%), spermatoceles in 39 bikers (46%), and epididymal calcifications in 34 bikers (40%). US findings in on-road cyclists were scrotoliths in 8 cyclists (16%), spermatoceles in 13 cyclists (26%), and epididymal calcifications in 6 cyclists (12%). The overall number of scrotal abnormalities was significantly greater in mountain bikers than in on-road cyclists (P < 0.001). CONCLUSIONS Mountain bikers compared with on-road cyclists have shown to be at a higher risk for scrotal disorders on US examination. Not only protective measures but also the awareness of the bikers are required to reduce the potential risk. Further studies should be undertaken to determine the clinical significance of the sonographic changes.
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313
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Tétreau R, Julian P, Lyonnet D, Rouvière O. Intratesticular varicocele: an easy diagnosis but unclear physiopathologic characteristics. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2007; 26:1767-1773. [PMID: 18029929 DOI: 10.7863/jum.2007.26.12.1767] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/25/2023]
Abstract
OBJECTIVE Intratesticular varicocele (ITV) is an uncommon sonographic finding with controversial data concerning its prevalence and physiopathologic characteristics. The goal of this study was to determine the prevalence of ITV in a urogenital imaging department and to describe its sonographic features. METHODS All identified cases of ITV were prospectively collected in the same imaging department. RESULTS Intratesticular dilated veins (>2 mm) with a positive response to the Valsalva maneuver were referred to as ITV. Nine cases of ITV were detected in 8 patients (mean age, 60 years; range, 30-85 years) in a series of 1832 scrotal sonographic examinations performed over 5 years (0.4%). A history of homolateral scrotal surgery was found in 5 cases. In most cases, ITV was left sided (6/9) and located in the mediastinum testis (6/9) with associated extratesticular varicocele (8/9) and testicular hypotrophy (7/9). Five of the 7 hypotrophic testes had other causes of hypotrophy. CONCLUSIONS Although variations do exist in the sonographic appearance of ITV, its specific sonographic and Doppler appearance should enable the radiologist to obviate further study. Intratesticular varicocele is often associated with ipsilateral testicular atrophy, but whether it is a cause or a consequence of testicular atrophy remains unclear.
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Affiliation(s)
- Raphaël Tétreau
- Department of Urinary and Vascular Radiology, Hospices Civils de Lyon, Hôpital Edouard Herriot, Lyon, F-69437, France
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314
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Kim SH, Park S, Choi SH, Jeong WK, Choi JH. Significant predictors for determination of testicular rupture on sonography: a prospective study. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2007; 26:1649-1655. [PMID: 18029916 DOI: 10.7863/jum.2007.26.12.1649] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/25/2023]
Abstract
OBJECTIVE The purpose of this study was to evaluate prospectively useful sonographic diagnostic criteria for testicular rupture in patients with blunt scrotal trauma and to determine significant predictors among the criteria. METHODS From July 2004 to February 2007, 29 consecutive patients (mean age, 22.8 years; range, 20-43 years) with blunt scrotal trauma who underwent scrotal sonography were enrolled. Ten ruptured testes and 6 intact testes were confirmed by surgery, and an additional 13 intact testes were confirmed by a physical examination. The sonographic findings were recorded with respect to contour irregularity, the presence of intratesticular and extratesticular heterogeneous echoes, loss of blood flow on color Doppler sonography, and engorgement of the pampiniform plexus by consensus between 2 radiologists. The sonographic findings used to diagnose testicular rupture were analyzed by the Fisher exact test, and significant predictors were determined by multiple regression analysis. RESULTS The ruptured testes showed contour irregularity (P=.0002), a heterogeneous intratesticular echo pattern (P=.0077), and loss of blood flow on color Doppler sonography (P=.0093). Engorgement of the pampiniform plexus was seen in most nonruptured testes (P=.0178). Contour irregularity was the only significant predictor for the diagnosis of testicular rupture (P=.0002). On the basis of this single predictor, diagnostic predictive values for sonography were calculated; the accuracy, sensitivity, and specificity were all 90%. The positive predictive value and negative predictive value were 82% and 94%, respectively. CONCLUSIONS Among the useful sonographic criteria, contour irregularity is the only significant predictor for the diagnosis of testicular rupture in patients with blunt scrotal trauma.
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Affiliation(s)
- Seung Ho Kim
- Department of Radiology, Armed Forces Capital Hospital, Gyeonggi-do, Korea.
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315
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Tsili AC, Tsampoulas C, Giannakopoulos X, Stefanou D, Alamanos Y, Sofikitis N, Efremidis SC. MRI in the Histologic Characterization of Testicular Neoplasms. AJR Am J Roentgenol 2007; 189:W331-W337. [DOI: 10.2214/ajr.07.2267] [Citation(s) in RCA: 55] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/30/2023]
Affiliation(s)
- Athina C. Tsili
- Department of Clinical Radiology, University Hospital of Ionnina, Leoforos S. Niarchou, 45500, Platia Pargis, 2, 453 32, Ioannina, Greece
| | - Constantine Tsampoulas
- Department of Clinical Radiology, University Hospital of Ionnina, Leoforos S. Niarchou, 45500, Platia Pargis, 2, 453 32, Ioannina, Greece
| | - Xenofon Giannakopoulos
- Department of Urology, University Hospital of Ionnina, Leoforos S. Niarchou, 45500, Ioannina, Greece
| | - Dimitrios Stefanou
- Department of Pathology, University Hospital of Ionnina, Leoforos S. Niarchou, 45500, Ioannina, Greece
| | - Yiannis Alamanos
- Department of Hygiene and Public Health, Panepistimioupolis, Leoforos S. Niarchou, 45500, Ioannina, Greece
| | - Nikolaos Sofikitis
- Department of Urology, University Hospital of Ionnina, Leoforos S. Niarchou, 45500, Ioannina, Greece
| | - Stavros C. Efremidis
- Department of Clinical Radiology, University Hospital of Ionnina, Leoforos S. Niarchou, 45500, Platia Pargis, 2, 453 32, Ioannina, Greece
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316
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Turgut AT, Olçücüoğlu E, Turan C, Kiliçoğlu B, Koşar P, Geyik PO, Koşar U, Dogra V. Preoperative ultrasonographic evaluation of testicular volume and blood flow in patients with inguinal hernias. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2007; 26:1657-1669. [PMID: 18029917 DOI: 10.7863/jum.2007.26.12.1657] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/25/2023]
Abstract
OBJECTIVE The purpose of this study was to investigate whether an inguinal hernia would have an impact on the testicular volume and blood flow by scrotal ultrasonography. METHODS Twenty-six male patients with unilateral inguinal hernias with a mean age of 48.1 years were included in the study. Testicular volumes were calculated, and spectral parameters such as the pulsatility index and resistive index of the testicular artery at supratesticular, subcapsular, and intratesticular levels on both the side with the inguinal hernia and the contralateral side were measured by a preoperative ultrasonographic examination. Comparisons between the dependent groups were performed by a Wilcoxon or paired samples t test where appropriate. RESULTS The mean +/- SD testicular volume on the side with the inguinal hernia was significantly higher than that on the contralateral testis (15.46+/-4.49 versus 14.54+/-3.65 mL, respectively; P<.05, Student t test). In addition, the mean resistive index of the intratesticular arteries was significantly higher on the side with the hernia compared with the contralateral side (0.66+/-0.06 versus 0.63+/-0.05; P<.05, Student t test). CONCLUSIONS These data indicate that an inguinal hernia may impair testicular blood flow, which may be attributable to an intermittent mechanical compression effect on the funiculus spermaticus in the inguinal canal.
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Affiliation(s)
- Ahmet T Turgut
- Department of Radiology, Ankara Training and Research Hospital, Ankara, Turkey.
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317
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Purushothaman H, Sellars MEK, Clarke JL, Sidhu PS. Intratesticular haematoma: differentiation from tumour on clinical history and ultrasound appearances in two cases. Br J Radiol 2007; 80:e184-7. [PMID: 17762053 DOI: 10.1259/bjr/19678081] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Intratesticular haematoma is not well described in the ultrasound literature and may be mistaken for a primary testicular malignancy if a detailed clinical history and careful ultrasound examination are not performed. We report two cases of intratesticular haematoma (one complicated by the presence of microlithiasis), describe the ultrasound appearances and document the natural history of the haematomas. A clinical history coupled with Doppler ultrasound features is crucial for conservative management.
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Affiliation(s)
- H Purushothaman
- Department of Radiology, King's College Hospital, Denmark Hill, London SE9 9RS, UK
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318
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Fernández-Usagre FJ, Rangel-Villalobos ME, García de la Oliva A, Blanco Yun A. [Doppler ultrasonography of scrotal injury]. RADIOLOGIA 2007; 49:183-7. [PMID: 17524336 DOI: 10.1016/s0033-8338(07)73747-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
OBJECTIVES To review the current body of knowledge about performing, understanding, and interpreting Doppler ultrasonography in scrotal injury. MATERIAL AND METHODS 17 patients with scrotal injury were studied. We describe the ultrasound technique and a wide spectrum of traumatic pathology together with its complications, analyzing the ultrasonographic signs and Doppler flow patterns that can orient the diagnosis and approach to treatment. RESULTS The most common posttraumatic lesions were epididymo-orchitis and (26%) and scrotal hematomas (25%). The most frequent complications were testicular ischemia (3 cases) and abscess formation (2 cases). The surgical emergencies were torsion (8%) and testicular rupture (8%). CONCLUSIONS Scrotal injuries can cause lesions that vary widely in severity, semiotics, and treatment. Doppler ultrasonography is an accurate tool in the hands of an experienced radiologist, enabling a clear, accurate diagnosis to be reached reasonably fast in pressing circumstances.
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319
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Kim W, Rosen MA, Langer JE, Banner MP, Siegelman ES, Ramchandani P. US–MR Imaging Correlation in Pathologic Conditions of the Scrotum. Radiographics 2007; 27:1239-53. [PMID: 17848688 DOI: 10.1148/rg.275065172] [Citation(s) in RCA: 164] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
Ultrasonography (US) is usually the initial imaging modality for evaluation of pathologic conditions of the scrotum. However, magnetic resonance (MR) imaging can be useful as a problem-solving tool when sonographic findings are equivocal. MR imaging allows characterization of scrotal masses as intratesticular or extratesticular and can demonstrate various types of lesions and tissue, including cysts or fluid, solid masses, fat, and fibrosis. MR imaging may be of value when the location of a scrotal mass is uncertain or when US does not allow differentiation between a solid mass and an inflammatory or vascular abnormality. Gadolinium-enhanced MR imaging can help differentiate between a benign cystic lesion and a cystic neoplasm. Gadolinium-enhanced imaging can also be used to demonstrate areas of absent or reduced testicular perfusion, such as in segmental testicular infarct. Finally, MR imaging can demonstrate an intraabdominal undescended testis, which can be difficult to detect with US, and is superior to US in differentiation between an undescended testis and testicular agenesis.
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Affiliation(s)
- Woojin Kim
- Department of Radiology, Hospital of the University of Pennsylvania, Philadelphia, PA 19104, USA.
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320
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Megremis S, Papamitsaki E, Ieromonachou P, Zois E. Inflammatory myofibroblastic tumor of the paratestis: sonographic appearance with pathologic correlation. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2007; 26:1227-30. [PMID: 17715318 DOI: 10.7863/jum.2007.26.9.1227] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/16/2023]
Affiliation(s)
- Stylianos Megremis
- First Department of Radiology, Venizelio General Hospital, Iraklio, Crete, Greece.
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321
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Abstract
Ultrasound is a vital adjunct to clinical examination in diagnosing scrotal disease, as a number of different processes may present similarly. Potential applications range from the acute emergency to long-term screening as well as cases in which a distinct scrotal abnormality may or may not be palpable. Differentiating acute epididymitis/epididymoorchitis from testicular torsion is possible sonographically, thereby guiding appropriate medical or surgical management. Distinguishing between cystic, solid, or complex scrotal masses is readily performed with this modality. It clearly depicts simple versus complex hydroceles and determines the presence of underlying testicular or epididymal disease. Not only is ultrasound the best imaging modality for longitudinal screening in patients (testicular microlithiasis, cryptorchidism) at risk for testicular tumors, it also provides valuable information in the infertile male by documenting the presence or absence of a varicocele.
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Affiliation(s)
- Monica Smith Pearl
- Department of Radiology, The George Washington University Hospital, Washington, DC 20037, USA
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322
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Abstract
Cryptorchidism represents a common condition affecting male infants that has significant clinical implications, including infertility and testicular malignancy. The precise developmental mechanisms leading to cryptorchidism are poorly understood; however, abnormalities in both functional anatomic and hormonal factors during embryogenesis and testicular descent are implicated. Although surgical intervention is ultimately required, there is a defined role for diagnostic imaging in patient evaluation-particularly in the setting of a nonpalpable undescended testis. Consultation among urologists, pediatric surgeons, and radiologists is paramount to optimize patient care.
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Affiliation(s)
- Jared D Christensen
- Department of Imaging Science, University of Rochester Medical Center, Rochester, NY 14642, USA
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323
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Abstract
Testicular torsion is one of the common causes of acute scrotal pain. This review discusses the clinical and sonographic findings of intravaginal and extravaginal testicular torsion, including the normal sonographic and vascular anatomy of the testis. The role of color flow Doppler and spectral Doppler is also emphasized in the patient's complete, incomplete, and intermittent testicular torsion. Sonographic features of testicular torsion mimics, such as vasculitis, venous thrombosis, scrotal edema, and technical parameters, are also presented. A brief description of new developments such as contrast-enhanced ultrasound, dynamic contrast magnetic resonance imaging, and near-infrared imaging is included.
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Affiliation(s)
- E P Lin
- Department of Imaging Sciences, University of Rochester School of Medicine, Rochester, NY, USA
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324
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Abstract
Sonography is the preferred imaging method for the evaluation of pediatric scrotal swelling. By identifying the site of origin and whether a mass is solid or cystic, the diagnosis is usually readily made, making ultrasound especially valuable in patient management. Scrotal pathology differs in pediatric patients, especially prior to puberty, making understanding of pediatric conditions essential. This article reviews the common intra- and extratesticular causes of pediatric scrotal swelling and their sonographic appearances.
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Affiliation(s)
- Brian D Coley
- Section of Ultrasound, Department of Radiology, Columbus Children's Hos pital, Ohio 43205, USA.
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325
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Karam JA, Baker LA. Focal orchitis presenting as bilateral testicular masses. J Pediatr Urol 2007; 3:337-9. [PMID: 18947769 DOI: 10.1016/j.jpurol.2006.10.004] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/04/2006] [Accepted: 10/09/2006] [Indexed: 11/16/2022]
Abstract
A 14-year-old male presented with bilateral scrotal pain. Ultrasound with Doppler revealed multiple bilateral testicular masses that were hypoechoic and hypervascular. Tumor markers and endocrinologic work-up were normal. Bilateral inguinal exploration of the testicles was done and biopsy revealed inflammation with no evidence of malignancy. The patient's pain resolved a few weeks postoperatively. Follow-up ultrasound revealed resolution of the masses. Multiple pathologic testicular entities can present as hypoechoic areas on sonography. Thorough work-up should be performed prior to advocating orchiectomy based only on ultrasound findings.
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Affiliation(s)
- Jose A Karam
- Department of Urology, University of Texas Southwestern Medical Center at Dallas, 5323 Harry Hines Blvd, Dallas, TX 75390-9110, USA
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326
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Briceño-García EM, Gómez-Pardal A, Alvarez-Bustos G, Artero-Muñoz I, Molinero MM, Seara-Valero R, Moreno-Ramírez V. Tuberculous orchiepididymitis after BCG therapy for bladder cancer. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2007; 26:977-9. [PMID: 17592062 DOI: 10.7863/jum.2007.26.7.977] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/16/2023]
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327
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Deurdulian C, Mittelstaedt CA, Chong WK, Fielding JR. US of acute scrotal trauma: optimal technique, imaging findings, and management. Radiographics 2007; 27:357-69. [PMID: 17374858 DOI: 10.1148/rg.272065117] [Citation(s) in RCA: 122] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
The primary causes of scrotal trauma are blunt, penetrating, degloving, and electrical burn injuries to scrotal contents. Knowledge of the scrotal anatomy and appropriate imaging techniques are key for accurate evaluation of scrotal injuries. Ultrasonography (US) is the first-line imaging modality to help guide therapy for scrotal trauma, except in degloving injury, which results in scrotal skin avulsion. Blunt injury (eg, from an athletic accident or motor vehicle collision) is the most common cause of scrotal trauma, followed by penetrating injury from gunshot or other assault. Trauma often may result in hematoma, hydrocele, hematocele, testicular fracture, or testicular rupture. The timely diagnosis of rupture, based on a US finding of discontinuity of the echogenic tunica albuginea, is critical because emergent surgery results in salvage of the testis in 80%-90% of rupture cases. The radiologist should be familiar also with other nuances associated with penetrating trauma, iatrogenic and postoperative complications, and electrical injury. Color flow and duplex Doppler imaging are highly useful techniques not only for assessing testicular viability and perfusion but also for evaluating associated vascular injuries such as pseudoaneurysms. A thorough familiarity with the US findings of scrotal trauma helps facilitate appropriate management. Supplemental material available at radiographics.rsnajnls.org/cgi/content/full/27/2/357/DC1.
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Affiliation(s)
- Corinne Deurdulian
- Department of Imaging, W.G. "Bill" Hefner V.A. Medical Center, Salisbury, NC 28144, USA.
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328
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Stewart VR, Sidhu PS. The testis: the unusual, the rare and the bizarre. Clin Radiol 2007; 62:289-302. [PMID: 17331822 DOI: 10.1016/j.crad.2006.10.005] [Citation(s) in RCA: 43] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2006] [Revised: 10/12/2006] [Accepted: 10/22/2006] [Indexed: 11/21/2022]
Abstract
Ultrasound is the preferred technique when imaging the scrotal contents. Although appearances of many of the more common abnormalities present the examiner with no diagnostic difficulty, the more unusual conditions may present a considerable challenge. Many normal variants, unusual and rare abnormalities may be instantly recognized once seen. The current review highlights the more unusual and rare conditions affecting the scrotal contents in order to allow the reader the opportunity to gain knowledge of their existence and to aid future interpretation of the difficult examination.
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Affiliation(s)
- V R Stewart
- Department of Radiology, King's College Hospital, London, UK
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329
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Turgut AT, Ozden E, Unsal A, Koşar P, Coşkun ZU, Koşar U. A novel parameter by EFOV US for the quantification and the distinction of physiological amount of scrotal fluid and hydrocele: ratio of testis volume/scrotum volume. Eur J Radiol 2007; 63:414-9. [PMID: 17339090 DOI: 10.1016/j.ejrad.2007.02.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2006] [Revised: 01/28/2007] [Accepted: 02/01/2007] [Indexed: 11/22/2022]
Abstract
OBJECTIVE To determine the limits for the amount of tunical fluid enough to be termed as hydrocele by using extended-field of view US technology and to define hydrocele for the first time with standard numerical criteria. METHODS A total of 60 patients were evaluated in this prospective study. Group 1 consisted of 20 patients with unilateral clinical hydrocele. Group 2 included 20 patients referred for scrotal US for reasons other than hydrocele. Group 3 comprised 20 male controls with no scrotal complaints. Testis volume (V(t)), scrotum volume (V(s)) and V(t)/V(s) ratio were calculated for each subject by dimensions measured in longitudinal and tranverse planes. RESULTS Mean V(t)/V(s) ratio was 0.28 +/- 0.17 (range, 0.07-0.57), 0.69 +/- 0.08 (range, 0.53-0.80) and 0.71 +/- 0.07 (range, 0.61-0.85) for groups 1, 2 and 3, respectively. Mean V(t)/V(s) for group 1 was significantly lower than those for groups 2 and 3, respectively (p<0.001 for each). Based on the ROC curve analysis, 0.55 for V(t)/V(s) ratio was determined as the optimal cut-off point below which the US diagnosis of hydrocele could be made (sensitivity 95.0% and specificity 97.5%). CONCLUSIONS We propose a novel US parameter of V(t)/V(s) ratio below 0.55 for a standard distinction between hydrocele and physiological amount of scrotal fluid.
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Affiliation(s)
- Ahmet Tuncay Turgut
- Department of Radiology, Ankara Training and Research Hospital, TR-06590 Ankara, Turkey.
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330
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Vital RJ, Mattos LAD, Souza LRMFD, Figueirêdo SDS, Szejnfeld J. Aspectos ultra-sonográficos das alterações não-neoplásicas do testículo. Radiol Bras 2007. [DOI: 10.1590/s0100-39842007000100013] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Processos patológicos dos testículos são muito comuns, incluindo-se lesões tumorais e não-tumorais neste contexto. A ultra-sonografia com transdutor de alta freqüência tornou-se a modalidade de imagem de escolha para a avaliação desses órgãos. Este método ajuda a melhor caracterizar lesões intratesticulares e em muitas situações sugere um diagnóstico mais específico, principalmente nos casos em que há manifestações clínicas similares, tais como dor, inchaço e aumento volumétrico locais. O mapeamento com Doppler colorido é importantíssimo para demonstrar padrões anormais de perfusão testicular e auxilia no diagnóstico de condições clínicas agudas. Neste ensaio iconográfico os autores sumarizam os mais comuns achados clínicos, patológicos e as principais características diagnósticas de lesões testiculares, tais como microlitíase, cisto simples, espermatocele, varicocele, ectasia tubular da rete testis, orquite, hematomas e condições mais raras. A familiaridade com as características ecográficas e clínicas destas alterações é essencial para o estabelecimento do diagnóstico correto e início da terapêutica mais eficaz, quando necessária.
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331
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Turgut AT, Ozden E, Koşar P, Koşar U, Cakal B, Karabulut A. Chronic constipation as a causative factor for development of varicocele in men: a prospective ultrasonographic study. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2007; 26:5-10. [PMID: 17182703 DOI: 10.7863/jum.2007.26.1.5] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/13/2023]
Abstract
OBJECTIVE The purpose of this study was to determine the role of chronic constipation in the etiopathogenesis of varicocele in men. METHODS In this prospective study, group 1 included 25 male patients who had symptoms of chronic constipation for a mean duration +/- SD of 17.0 +/- 20.3 months (range, 3-96 months), and group 2 included 26 male subjects without any symptoms associated with constipation. All subjects were evaluated by both physical examination and scrotal ultrasonography. For the plexus pampiniformis (PP) veins, a mean diameter exceeding 2 mm and reflux for more than 1 second were accepted as suggestive findings for varicocele, as described previously. RESULTS Left varicocele was detected in 13 (52%) of the 25 patients in group 1 and in 5 (19%) of the 26 subjects in group 2 (P = .02). The mean diameters of the left PP veins were 2.58 +/- 0.97 mm (range, 1.2-4.3 mm) in group 1 and 1.71 +/- 0.53 mm (range, 1.0-3.0 mm) in group 2 (P < .001). A significant difference was detected between the two groups for varicocele prevalence and the mean diameter of the left PP veins. CONCLUSIONS Chronic constipation is a significant causative factor for the development of left varicocele, which may be attributable to the accompanying distention of the sigmoid colon and distal part of the descending colon, with resultant compression of the left testicular vein in the retroperitoneum. Therefore, we propose routine ultrasonographic examinations for the possible development of varicocele in men with chronic constipation.
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Affiliation(s)
- Ahmet T Turgut
- Department of Radiology, Ankara Training and Research Hospital, Ankara, Turkey.
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332
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Xu HX, Yi XP. Sonographic appearance of a testicular yolk sac tumor in a 2-year-old boy. JOURNAL OF CLINICAL ULTRASOUND : JCU 2007; 35:55-7. [PMID: 16960883 DOI: 10.1002/jcu.20249] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/11/2023]
Abstract
Yolk sac tumor (YST) of testis is the most common of all childhood testicular malignancies. We report a case of testicular YST in a 2-year-old boy. The tumor appeared sonographically as an ovoid, homogeneous, well-circumscribed, isoechoic, solid testicular mass with good sound-through transmission and increased internal vascularity on color Doppler imaging. The serum alpha-fetoprotein level was 4,396 ng/ml. Pathological examination confirmed YST at at stage I. Although the sonographic appearance of YST of the testis is nonspecific, the diagnosis is achievable in clinical practice on the combination of elevated serum alpha-fetoprotein level and sonograms depicting a solid testicular hypervascular mass.
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Affiliation(s)
- Hui-Xiong Xu
- Department of Medical Ultrasonics, The First Affiliated Hospital, Sun Yat-Sen University, Guangzhou, PR China
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333
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334
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Kim YJ, Lee MW, Jeon HJ, Yi JG, Paick SH, Kim HG, Lim SD, Hwang TS. Sparganosis in the scrotum: sonographic findings. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2007; 26:129-31. [PMID: 17182719 DOI: 10.7863/jum.2007.26.1.129] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/13/2023]
Affiliation(s)
- Young Jun Kim
- Department of Radiology, Konkuk University School of Medicine, 4-12 Hwayang-dong, Gwangjin-gu, Seoul 143-729, Korea.
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335
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336
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Germaine P, Simerman LP. Fibrous pseudotumor of the scrotum. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2007; 26:133-8. [PMID: 17182720 DOI: 10.7863/jum.2007.26.1.133] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/13/2023]
Affiliation(s)
- Pauline Germaine
- Department of Radiology, Pennsylvania Hospital, Philadelphia, PA 19107, USA
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337
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Stewart VR, Sriprasad S, Pomplun S, Walsh K, Sidhu PS. Sonographic features of a spermatic cord capillary hemangioma. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2007; 26:139-42. [PMID: 17182721 DOI: 10.7863/jum.2007.26.1.139] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/13/2023]
Affiliation(s)
- Victoria R Stewart
- Department of Radiology, King's College Hospital, Denmark Hill, London SE5 9RS, England
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338
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Abstract
Testicular pain has a variety of etiologies, including torsion, inflammation, trauma, and cancer. Differentiation of these diseases is important for proper treatment and prevention of further complications. A most noteworthy cause of testicular pain may be testicular torsion, in which a delayed diagnosis could result in the loss of the testis. Sonography plays a major role in the diagnosis of testicular torsion. Both gray-scale and color Doppler sonography aid in deriving a specific diagnosis that will help the physician in managing the condition. A case of an elderly man with testicular discomfort and complex hydrocele is presented.
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Affiliation(s)
- Johan Ghazali
- British Columbia Institute of Technology, School of Health Sciences, Burnaby, British Columbia, Canada; Boucher Institute of Naturopathic Medicine, 320-435 Columbia Street, New Westminster, British Columbia, Canada V3L 5N8
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339
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340
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Nussbaum Blask AR, Rushton HG. Sonographic Appearance of the Epididymis in Pediatric Testicular Torsion. AJR Am J Roentgenol 2006; 187:1627-35. [PMID: 17114561 DOI: 10.2214/ajr.05.0461] [Citation(s) in RCA: 43] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
OBJECTIVE The purpose of this study was to determine the frequency of an enlarged epididymis in pediatric patients with testicular torsion and to determine whether an altered epididymis might be a helpful ancillary sonographic sign of testicular torsion. MATERIALS AND METHODS The sonograms of 50 pediatric patients (age range, neonate-17 years) with testicular torsion were retrospectively reviewed for the size, appearance, and blood flow of the epididymis. Medical records were reviewed for surgical and pathologic findings and to determine whether testicular salvage had been possible. RESULTS The epididymis was enlarged (maximum dimension, 5.5 cm) in 47 of the 50 patients with acute or late phase torsion and after manual or spontaneous detorsion. The average difference in volume between the ipsilateral epididymis and the contralateral epididymis was 30 cm3, highly significant (p < 0.0001). The shape of the epididymis was altered in 92% of the cases (globular, bilobular, or multilobular). Seventy-three percent showed increased echogenicity and 27% appeared isoechoic. Of those with active torsion, 93% of the epididymides were avascular; 2%, hypovascular; and 5%, hypervascular. After detorsion, 100% of the epididymides (10/10) had blood flow. In patients with testicular loss due to infarction, pathology showed engorgement and enlargement of the epididymis with hemorrhagic infarction. In one patient with a hypervascular epididymis, surgery showed inflammation and erythema of the epididymis. Testicular loss occurred in each type of epididymal flow pattern. CONCLUSION A markedly enlarged, echogenic, and avascular or hypovascular epididymis is an ancillary sonographic sign in pediatric patients with testicular torsion. A hypervascular enlarged epididymis infrequently occurs (5% of cases) and should not be mistaken for epididymitis. In addition, the return of epididymal blood flow is an ancillary sign of successful testicular detorsion.
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Affiliation(s)
- Anna R Nussbaum Blask
- Department of Radiology, Children's National Medical Center, 111 Michigan Ave., NW, Washington, DC 20010, USA.
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341
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Connolly SS, D'Arcy FT, Gough N, McCarthy P, Bredin HC, Corcoran MO. Carefully selected intratesticular lesions can be safely managed with serial ultrasonography. BJU Int 2006; 98:1005-7; discussion 1007. [PMID: 17034602 DOI: 10.1111/j.1464-410x.2006.06451.x] [Citation(s) in RCA: 33] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
OBJECTIVE To evaluate a policy of conservative non-operative management for incidental, impalpable, < 1 cm, intratesticular pathology. PATIENTS AND METHODS We retrospectively reviewed all scrotal ultrasonograms within an 8-year period to identify all radiological lesions of < 1 cm within the testis. All palpable lesions and those accompanied by elevated tumour markers or disseminated malignancy were managed surgically. The remaining incidentally detected lesions were followed with a protocol of serial ultrasonography (US). RESULTS Of 1544 scans reviewed, 12 (0.8%) lesions suitable for observational management were identified. The mean (range) age of the patients was 54 (34-76) years. The indication for US was suspected epididymitis in five, contralateral epididymal cyst in five and infertility in two patients. The mean (range) size of the lesion was 4.9 (1.5-9.8) mm. Three anechoic lesions were consistent with intratesticular cysts, and each was followed with no change to a mean (range) follow-up of 26 (12-48) months. Eight hypoechoic lesions were followed to a mean of 34 (4-72) months, and only one showed growth on repeat US after an interval of 4 months, and was diagnosed as a 1.0-cm seminoma after orchidectomy. One hyperechoic lesion remains unchanged at 6 months of follow-up. CONCLUSION Supported by previous reports suggesting that most testis lesions of < 1 cm are benign, we managed a series of carefully selected intratesticular lesions conservatively, the behaviour in most being in keeping with benign pathology.
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Affiliation(s)
- Stephen S Connolly
- Department of Urology, University College Hospital Galway, National University of Ireland, Galway, Ireland.
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342
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Breysem L, Herman M, Moerman P, Van Damme-Lombaerts R, Bogaert G, Smet M. High-resolution sonography of a scrotal abscess in a 2-week-old infant. Pediatr Radiol 2006; 36:1186-9. [PMID: 16932920 DOI: 10.1007/s00247-006-0273-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2006] [Revised: 06/19/2006] [Accepted: 06/19/2006] [Indexed: 10/24/2022]
Abstract
Scrotal abscess in infancy is rare and, in an otherwise healthy infant, an unexpected pathology. We present a 2-week-old boy with a unilateral scrotal swelling, imaged by high-resolution sonography. Sonography with colour Doppler demonstrated an encapsulated heterogeneous mass in the left scrotum with surrounding hyperaemia and a hypervascular spermatic cord. The testis was not demonstrable with full certainty and surgical exploration was undertaken. A scrotal abscess, indistinguishable from the testis and epididymis, had to be resected and on histology was found to have originated from the tunica vaginalis. Urogenital investigations did not reveal any associated abnormality and the final diagnosis was idiopathic scrotal abscess. High-resolution sonographic features with colour Doppler of a scrotal swelling can suggest an abscess and help determine appropriate therapy.
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Affiliation(s)
- Luc Breysem
- Department of Radiology, University Hospitals, Herestraat 49, Leuven 3000, Belgium.
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343
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Uppuluri S, Bhatt S, Tang P, Dogra VS. Clear cell papillary cystadenoma with sonographic and histopathologic correlation. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2006; 25:1451-3. [PMID: 17060433 DOI: 10.7863/jum.2006.25.11.1451] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/12/2023]
Affiliation(s)
- Sarada Uppuluri
- Department of Radiology, University of Rochester School of Medicine, Rochester, NY 14642 USA
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344
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Puttemans T, Delvigne A, Murillo D. Normal and variant appearances of the adult epididymis and vas deferens on high-resolution sonography. JOURNAL OF CLINICAL ULTRASOUND : JCU 2006; 34:385-92. [PMID: 16944482 DOI: 10.1002/jcu.20257] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/11/2023]
Abstract
PURPOSE To describe the appearance, anatomic position, and size of the normal adult epididymis and vas deferens using high-resolution sonography. METHODS The sonographic appearance, anatomic position, and size of the epididymal head (EH), epididymal body (EB), epididymo-deferential loop (EDL), and vas deferens (VD) were evaluated in 112 consecutive infertile men (infertile group), and the data were compared with those from 84 consecutive men without history of infertility (reference group). RESULTS Compared with the testis, the EH was isoechoic, the EB hypoechoic, and the VD anechoic. In 88.4% of cases in the infertile group and 97.6% of cases in the reference group, the EH was located above the upper pole of the testis, with the EB lateral to the testis and the EDL below the lower pole of the testis. In 9% of cases in the infertile group and 6% of cases in the reference group, the EB was located posterior to the body of the testis, with the EDL inverted and the VD anterior to the ET. In 11.6% of cases in the infertile group and 2.4% of cases in the reference group, the epididymis was inverted, with the EH located below the lower pole of the testis. The mean (+/-SD) normal sizes were as follows: EH, 7.6 +/- 1.6 mm; EB, 3.2 +/- 0.8 mm; EDL, 7.7 +/- 1.3 mm; VD, 1.9 +/- 0.2 mm. No statistically significant differences in size were found between the 2 groups. CONCLUSIONS We describe the normal and variant appearance, position, and size of the adult epididymis and VD on high-resolution sonography.
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Affiliation(s)
- Thierry Puttemans
- Imagerie Médicale, Hôpital Iris Sud, Site Etterbeek-Ixelles, Rue Jean Paquot 63, 1050 Brussels, Belgium
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345
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Müller T, Gozzi C, Akkad T, Pallwein L, Bartsch G, Steiner H. Management of incidental impalpable intratesticular masses of ≤ 5 mm in diameter. BJU Int 2006; 98:1001-4. [PMID: 16956359 DOI: 10.1111/j.1464-410x.2006.06485.x] [Citation(s) in RCA: 57] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
OBJECTIVE To gain more insight into the histology of small incidental intratesticular lesions and evaluate the need for surgical management, as exploratory surgery is the only way to exclude malignancy in testicular tumours. PATIENTS AND METHODS Between September 2000 and April 2005, incidental intratesticular masses of < or = 5 mm in diameter were found in 20 men undergoing scrotal ultrasonography for reasons other than suspected testicular tumour. After staging, an organ-sparing approach including frozen-section analysis was used to obtain histological data. RESULTS The mean diameter of the detected tumour masses was 3.5 mm, and the mean (range) age of the patients was 36.4 (26-58) years. Four men (20%) had orchidectomy because the tumours were found to be malignant; the resected specimens yielded multifocal testicular intraepithelial neoplasia (TIN) in all patients and additional seminomatous tumour cells elsewhere in the testis in one. Frozen-section results were false-negative in one patient and he had orchidectomy after having established the definitive histological diagnosis. The 16 patients with benign lesions were correctly diagnosed and their testicles were not removed. CONCLUSIONS Advanced and innovative ultrasonography technology allows the detection of increasingly small testicular masses. In the present series, most incidental intratesticular lesions were benign. In patients with malignant lesions, multifocal TIN and/or distant seminomatous foci were present despite the tumour being small. Therefore, it is essential to perform exploratory surgery as it is the only way to obtain accurate histological findings, thus providing oncological efficacy and precluding removal of a testicle bearing a benign lesion.
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Affiliation(s)
- Tilko Müller
- Department of Urology and Radiology, Medical University Innsbruck, Austria
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346
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Abstract
Ultrasonography allows providers to noninvasively image an area of interest in real time without the risks of ionizing radiation or nephrotoxic contrast agents. This article present basic concepts of ultrasound along with new advances in ultrasound technology and their applications in small parts evaluation.
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Affiliation(s)
- Eric A Singer
- University of Rochester Medical Center, 601 Elmwood Avenue, Box 648, Rochester, NY 14642, USA
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347
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Turgut AT, Unsal A, Ozden E, Kosar P, Kosar U, Emir L. Unilateral idiopathic hydrocele has a substantial effect on the ipsilateral testicular geometry and resistivity indices. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2006; 25:837-43. [PMID: 16798894 DOI: 10.7863/jum.2006.25.7.837] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/10/2023]
Abstract
OBJECTIVE The purpose of this study was to determine whether hydrocele has any effect on the volume and shape of the ipsilateral testis and can be implicated as a cause of testicular ischemia. METHODS Group 1 consisted of 23 patients with unilateral idiopathic hydrocele, whereas 30 healthy men constituted group 2. All patients underwent scrotal ultrasonography by which testicular dimensions in craniocaudal (D(cc)), anteroposterior (D(ap)), and mediolateral axes were measured, followed by calculation of the D(cc)/D(ap) ratio and testicular volume. By color Doppler analysis, the resistivity index of the subcapsular artery (RI(sc)) and the resistivity index of the intratesticular artery were determined. RESULTS The mean D(cc)/D(ap) ratio +/- SD for group 1 was 1.7 +/- 0.3 (range, 1.1-2.3), significantly lower than that of group 2, which was 1.9 +/- 0.3 (range, 1.3-2.2) (P = .028). Mean testicular volume values of subjects having hydrocele for more than and less than 6 months were 13.4 +/- 7.3 and 22.5 +/- 5.1 cm3, respectively; the difference between the subgroups was significant (P = .003). For the ipsilateral testis, mean RI(sc) values were 0.70 +/- 0.06 (range, 0.60-0.80) in group 1 and 0.65 +/- 0.06 (range, 0.59-0.83) in group 2. The mean RI(sc) was significantly higher in group 1 (P = .006). CONCLUSIONS Unilateral idiopathic hydrocele has a tendency for rounding rather than flattening the ipsilateral testis as well as elevating the RI(sc) on the affected side. To the best of our knowledge, no strict spectral Doppler analysis criteria have been proposed for testicular ischemia yet. Therefore, the impact of the difference of the RI(sc) should raise the suspicion for ischemia, and further research is needed to elucidate any effect on spermatogenesis.
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348
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Thierman JS, Clement GT, Kalish LA, O'Kane PL, Frauscher F, Paltiel HJ. Automated sonographic evaluation of testicular perfusion. Phys Med Biol 2006; 51:3419-32. [PMID: 16825740 DOI: 10.1088/0031-9155/51/14/010] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Contrast-enhanced ultrasound (US) imaging is potentially applicable to the investigation of vascular disorders of the testis. We investigated the ability of two automated computer algorithms to analyse contrast-enhanced pulse inversion US data in a rabbit model of unilateral testicular ischaemia and to correctly determine relative testicular perfusion: nonlinear curve fitting of the US backscatter intensity as a function of time; and spectral analysis of the intensity time trace. We compared (i) five metrics based on the algorithmic data to testicular perfusion ratios obtained with radiolabelled microspheres, a reference standard; (ii) qualitative assessment of the US images by two independent readers blinded to the side of the experimental and control testes to the radiolabelled microsphere perfusion ratios; and (iii) results of the algorithmically-derived metrics to the qualitative assessments of the two readers. For the curve fit method, the algorithmically-derived metrics agreed with the reference standard in 54% to 68% of all cases. For the spectral method, the results agreed in 70% of all cases. The two readers agreed with the reference standard in 40% and 35% of all cases, respectively. These results suggest that automated methods of analysis may provide useful information in the assessment of testicular perfusion.
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349
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Paltiel HJ, Kalish LA, Susaeta RA, Frauscher F, O'Kane PL, Freitas-Filho LG. Pulse-Inversion US Imaging of Testicular Ischemia: Quantitative and Qualitative Analyses in a Rabbit Model. Radiology 2006; 239:718-29. [PMID: 16641337 DOI: 10.1148/radiol.2393050210] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
PURPOSE To quantitatively and qualitatively assess perfusion with pulse-inversion (PI) ultrasonography (US) in rabbit model of acute testicular ischemia. MATERIALS AND METHODS Institutional animal care committee approval was obtained. After 35 rabbits underwent unilateral spermatic cord occlusion, testicular Doppler US and contrast material-enhanced PI imaging were performed. Enhancement data yielded perfusion measurements including mean value during the first 10 seconds, mean value over entire recorded replenishment curve, and curve slope during the first 5 seconds. Calculated perfusion ratios were compared with radiolabeled microsphere-derived perfusion ratios. Two readers assessed testicular perfusion as none, possible, or definite and relative perfusion as greater to the right testis than to the left, greater to the left testis than to the right, or as equal to both testes. With kappa statistics, interobserver agreement for all imaging methods was determined. Association between qualitative perfusion categories and radiolabeled microsphere-based perfusion measurements was assessed. Quantitative and qualitative determinations of relative perfusion were compared with radiolabeled microsphere-based measurements. RESULTS Correlations between calculated and radiolabeled microsphere-based perfusion ratios were determined (r=0.49-0.64). Interobserver agreement for presence of perfusion was excellent (kappa=0.76), and that for relative perfusion assessment was good (kappa=0.55). Neither kappa value varied significantly with imaging method. The percentage of times a testis classified as having definite perfusion had greater perfusion as measured with radiolabeled microspheres than a testis classified as having no perfusion or possible perfusion was higher with PI imaging than with Doppler US (85%-98% vs 72%-89%). Identification of the testis with less perfusion was better with quantitative methods than with qualitative assessment of images by the readers (75%-79% vs 34%-60%, P<.004). CONCLUSION PI imaging, compared with conventional Doppler US methods, provides superior assessment of perfusion in the setting of acute testicular ischemia.
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Affiliation(s)
- Harriet J Paltiel
- Department of Radiology, Children's Hospital Boston, Harvard Medical School, 300 Longwood Ave, Boston, MA 02115, USA.
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350
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Abstract
Ultrasound plays an important role and adds essential information in diagnosing benign intrascrotal lesions. Characterization of benign intrascrotal lesions with sonography, in combination with clinical assessment, can lead to nonsurgical management or testicular sparing surgery. We present important sonographic features of benign intrascrotal lesions, including extratesticular lesions: adenomatoid tumors, papillary cystadenomas, spermatoceles, hydroceles, varicoceles, hernias; and intratesticular lesions: tunica albuginea cysts, testicular simple cysts, epidermoid cysts, tubular ectasia of the rete testis, intratesticular varicoceles, adrenal rest tumors, and splenogonadal fusion. The goal of this review is to provide the radiologist with a better understanding of benign lesions that occur in the scrotum.
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Affiliation(s)
- Shweta Bhatt
- Deparment of Imaging Sciences University of Rochester School of Medicine, University of Rochester Medical Center, Rochester, New York 14642, USA
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