Scrotum - Gog

8/22/2019 Scrotum - Gog

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TESTICULAR IMAGING

GOG LASUCOM/18/09/12

SCROTUM-A Pouch of skin that houses the TESTES. Epididymis and spermatic

cord.

-Has three layers-from superficial to deep skin-Dartos muscle and

colles fascia.

-Divided into two compartments by midline fibrous septum (

median Raphe ).

-Each compartment contains a testicle, epididymis and spermatic

cord.

The testicles originate from the posterior abdominal wall around

the level of L1 and descend retroperitoneally through the abdomen

with associated neurovascular structures lymphatics , ducts exit the

pelvis via the inguinal canal into the scrotum.


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Anatomy

Adult testes are ovoid glands measuring 3-5cm in length, 2-4cm inwidth and 3cm in anteroposterior dimension. Each testis weightfrom 12.5-19grams. Testicular size and weight decrease with age.

Testes are surrounded by a dense white fibrous capsule - TunicaAlbuginea. Epididymis is a curved structure 6-7cm in length lyingposterolateral to the testis. Diagnostic Ultrasound is the mostcommon imaging technique used in supplementing physicalexamination of the scrotum.

IMAGING OF THE TESTIS KUB

ULTRASOUND

RUCG

MRI

CT SCAN

DOPPLER SCAN

RADIONUCLIDE IMAGING - SCROTAL SCINTIGRAPHY

ANGIOGRAPHY

VASOGRAPHY


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UNDESCENDED TESTIS (CRYPTORCHIDISM)

In majority of prepubertal males, the testes may normally beretractile into the groin because of the cremasteric muscle reflex.Once the testicle cannot be located within the scrotum it can be

considered undescended. Failure of descent by 2-3years age is associated with abnormal

development

Testes that remain undescended in boys above 5 years suffer froman increased incidence of malignant neoplasia up to 40 times.

ULTRA SOUND-(quick and able to locate the testicle at itscommonest sites {within the inguinal canal or just proximal to it} )1st Line Investigation to locate an undescended testicle. The longerthe testis has been undescended the more likely it is to be small,atrophic and echo-poor.

MRI- for more expansive search; better than CT as it avoidsradiation.

Testicle shows a conspicuous high signal on T2-weighted and STIRsequences.

Testicular Phlebography or Arteriography in search forundescended testis.


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EXTRATESTICULAR SCROTAL DISORDERS

Hydrocele(epididymo- orchitis, trauma, infarction{torsion}) or- formation of fluid between the 2-

layers(visceral and parietal of the tunica vaginalis . -seen ultasonographically, it is seen as an echo-free

area partly surrounding the testicle.

Cyst varicocele

TESTICULAR DISORDERS ORCHITIS

Testicular appendix torsion

Scrotal trauma

Testicular masses

Testicular lymphoma

Testicular microlithiasis

Testicular calcification


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Current Uses of Scrotal Sonography

Evaluation of location and characteristics of scrotal

masses.

Detection of occult primary tumor in patients in the

known metastatic disease.

Follow up of the patients with Microlithiasis. Follow up of patients with leukemia, lymphoma and

previous testicular neoplasm.

Evaluation of extra testicular pathologic lesions. Evaluation of Acute Scrotal pain.

Evaluation of Scrotal trauma.

Localisation of an undescended testis.


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Detection of varicoceles in infertile men.

Evaluation of testicular/ischemia with color flow

Doppler.

Technique

The Scrotum is elevated with a towel draped over

the thighs while the penis is placed on the patientsabdomen covered with a towel. Scrotal sac may be

supported by the examiners hand.

Images of both testes are obtained in transverse

and sagittal planes. Color flow Doppler

examinations are done to evaluate testicular blood

flow in normal and pathologic states.


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