1. Testicular Ultrasound
Alexis P Langsfeld MD
St Luke’s-Roosevelt Emergency Department
Ultrasound Division

2. Male Anatomy Testes are oval shaped inside scrotum
Average size 4 x 3 x 2.5
10-19 gms
Surrounded by tunica vaginalis
Tunica albuginea separates lobes within the testes
Epididymis tail forms vas deferens

3. Male Anatomy

4. Testicular Anatomy

5. Vascular Supply Arterial flow from aorta by testicular artery
Deferential and cremasteric arteries supply extra testicular components, collaterals to testes
Venous flow via testicular vein

6. Technique Reassurance Analgesia Warm Gel Frog leg
Towel under scrotum and over penis
Unaffected testes first

7. Technique High frequency probe Color and Spectral Doppler
Spectral allows differentiation between arterial and venous Flow
Venous flow is compromised first

8. Technique B-mode 2 views View full testes with color flow
Identify blood flow around epididymis
Identify vascular pulse
Color-flow doppler to assess for venous vs. arterial flow.
Venous flow is affected first in early vascular insufficiency

9. Sonographic Appearance
Homogenous, similar to liver
Minimal low flow throughout
Epididymis superior to testes
Extra testicular structure
more ecchogenic
Appendix testes superior aspect of testes
normally covered by epididymal head

10. Normal Testicular Exam

11. Identify
Testicle
Epididymis
Head
Body
Tail
Arterial Flow
Venous Flow

12. Views
Longitudinal and cross section

13. Indications
Testicular pain
Testicular mass
Testicular Trauma

14. Differential Diagnosis
Epididymitis
Orchitis
Trauma
Torsion
Varicoceale/ Hydroceal
Hernia

15. Epididymitis Most common cause of ED presentation for scrotal pain
Infection and inflammation within the epididymis
GC/ Chlamydia < 35
E-Coli >35
Gradual onset
Poor historians
Pain threshold

16. Epididymitis

17. Epididymitis

18. Hydrocele Fluid around testes
Result from communication w/ abdominal cavity
Often congenital
My be result of trauma, infection,neoplasm, or torsion

19. Hydrocele

20. Varicocele Vessels in scrotum due to structural defect “Bag of worms”
Can cause infertility by keeping testes at higher heat
Gradual onset

21. varicocele

22. Vacicocele

23. Hernia Bowel contents fall through abdominal wall defect into scrotum
Can become incarcerated/ torse
Inflammation can cause vessel compression
Gradual onset

24. Mass Generally slow growing Non-Acute Hydrocele / Varicocele Neoplasm
Generally soft & non-tender
Neoplasm
Firm
Risk of hemorrhage

25. Testicular Cancer

26. Trauma Swelling and pain after direct trauma
Laceration, Hemorrhage, Contusion, Capsular rupture, Torsion
Poor physical exam
Ultrasound evaluation Necessary

27. Torsion
To Be discussed at later lecture

28. Epididymitis vs. Torsion
Epididimitis
Enlarged
Hypoechoic
Increased Vascularity
Torsion
Enlarged
Hypoechoic
Decreased vascularity

29. Epididymitis vs. Torsion
20% overlap in symptoms
Difficult to differentiate with swelling and tenderness
Different treatment plans

30. Appendix Testes Torsion
To be discussed at later Lecture

31. Conclusion Image in 2 views Use color to asses blood flow
Use doppler to quantify blood flow
Take the testicles seriously

32. Resa Lewis for Images Ultrasound Division
Thank You
Resa Lewis for Images
Ultrasound Division