Learning objectives
Learning objectives:
To review developmental scrotal embryology and anatomy and relate this to localising scrotal pathology as intra or extra testicular. Define the principles of ultrasound (US) for diagnosis in this context and provide an overview of extra testicular pathologies by identifying key imaging findings.
Background
Clinical history and examination of patients presenting with scrotal symptoms frequently overlap between different aetiologies,
lacking in specificity of both location and in diagnostic differentials.
An extra-testicular lesion may originate from epipidymis,
spermatic cord or tunica vaginalis,
with each of these structures potentially affected by a wide variety of pathologic processes (1).
The differential for extra testicular lesions includes cystic and solid lesions,
and may be complex to diagnose although predominantly benign.
This educational poster aims to illustrate their US appearances in the clinical context.
Findings and procedure details
Introduction
Extra-testicular lesions may present as scrotal masses or incidental findings. They can originate from epipidymis,
spermatic cord or tunica vaginalis,
with each of these structures potentially affected by a variety of pathologic processes.
Ultrasonography (US) with a high-frequency transducer (8-15 MHz) is the first choice of diagnostic imaging of scrotal masses.
US is able to identify and characterise intratesticular or extratesticular lesions,
may distinguish between benign or malignant lesions and identify conditions requiring emergent surgical intervention.
Majority (97%) of extra-testicular lesions (as opposed to...
Conclusion
US is the first line imaging investigation in any patient presenting with scrotal symptoms. By understanding developmental anatomy and distinctive imaging appearances of extratesticular pathology the radiologist can provide an accurate differential diagnosis and improve the patient pathway. Where necessary,
MRI is the most suitable additional investigation for further evaluation.
References
1.
Woodward P,
Schwab C,
Sesterhenn I.
Extratesticular Scrotal Masses: Radiologic-Pathologic Correlation.
Radiographics.
2003;23(1).
2.
Tsili A,
Bertolotto M,
Turgut A,
Dogra V,
Freeman S,
Rocher L,
et al.
MRI of the scrotum: Recommendations of the ESUR Scrotal and Penile Imaging Working Group.
Eur Radiol.
2018;28(1):12.
3.
Rafailidis V,
Robbie H,
Konstantatou E,
Huang D,
Deganello A,
Sellars M,
et al.
Sonographic imaging of extra-testicular focal lesions: comparison of grey-scale,
colour Doppler and contrast-enhanced ultrasound.
Ultrasound.
2016;24(1):10.
4.
Kuhn A,
Scortegagna E,
Nowitzki K,
Kim...