Sonographic Appearances of Infection, Trauma, and Fluid Collections

Scrotal Infection, Trauma, and Fluid Collection Sonographic Appearances

• Epididymitis: Enlarged epididymis, heterogeneous texture, hypoechoic, may contain hyperechoic areas, blood flow in the epididymis.

• Focal Orchitis: Hypoechoic area within the testicle, blood flow in the testicle.

• Diffuse Orchitis: Enlarged hypoechoic testicle, overall testicle echogenicity affected.

• Rupture: Irregular contour, focal change in echogenicity.

• Hematoma: Heterogeneous area, becomes hyperechoic as it ages, avascular.

• Torsion:

• Normal testicle appearance if duration < 4 hours

• Enlarged and hypoechoic testicle if duration is 4-12 hours.

• Heterogeneous testicle after 24 hours.

• Absence of testicular blood flow.

• Hydrocele: May be anechoic but often contains low-level echoes, surrounds the anterolateral aspect of the testicle.

• Spermatocele: Located in the head of the epididymis, may contain internal echoes or septations, smooth walls, posterior acoustic enhancement.

• Epididymal Cyst: Located anywhere in the epididymis, usually small and anechoic, ultrasound cannot differentiate from spermatocele, posterior acoustic enhancement.

• Varicocele: Tortuous, dilated veins, increased size with Valsalva maneuver or standing, dilated veins fill with color on Valsalva maneuver, spectral Doppler confirms venous flow.

• Hematocele: Contains low-level echoes, may contain septations and loculations.