Epididymitis

Definition

Scrotal ultrasound is an imaging technique used for the diagnosis of suspected abnormalities of the scrotum. It uses harmless, high frequency sound waves to form an image. The sound waves are reflected by scrotal tissue to form a picture of internal structures. It is not invasive and involves no radiation.

Purpose

Ultrasound of the scrotum is the primary imaging method used to evaluate disorders of the testicles and surrounding tissues. It is used when a patient has acute pain in the scrotum. Some of the problems for which the use of scrotal ultrasound is valuable include an absent or undescended testicle, an inflammation problem, testicular torsion, a fluid collection, abnormal blood vessels, or a mass (lump or tumor).

A sudden onset of pain in the scrotum is considered a serious problem, as delay in diagnosis and treatment can lead to loss of function. Epididymitis is the most common cause of this type of pain. Epididymitis is an inflammation of the epididymis, a tubular structure that transports sperm from the testes. It is most often caused by bacterial infection, but may occur after injury, or arise from an unknown cause. Epididymitis is treatable with antibiotics, which usually resolves pain quickly. Left untreated, this condition can lead to abscess formation or loss of blood supply to the testicle.

Testicular torsion is the twisting of the spermatic cord that contains the blood vessels which supply the testicles. It is caused by abnormally loose attachments of tissues that are formed during fetal development. Torsion can be complete, incomplete, or intermittent. Spontaneous detorsion, or untwisting, can occur, making diagnosis difficult. Testicular torsion arises most commonly during adolescence, and is acutely painful. Scrotal ultrasound is used to distinguish this condition from inflammatory problems, such as epididymitis. Testicular torsion is a surgical emergency; it should be operated on as soon as possible to avoid permanent damage to the testes.

A scrotal sac with an absent testicle may be the result of a congenital anomaly (an abnormality present at birth), where a testicle fails to develop. More often, it is due to an undescended testicle. In the fetus, the testicles normally develop just outside the abdomen and descend into the scrotum during the seventh month. Approximately three percent of full term baby boys have undescended testicles. It is important to distinguish between an undescended testicle and an absent testicle, as an undescended testicle has a very high probability of developing cancer.

Ultrasound can be used to locate and evaluate masses in the scrotum. Most masses within the testicle are malignant or cancerous, and most outside the testicle are benign. Primary cancer of the testicles is the most common malignancy in men between the ages of 15-35. Fluid collections and abnormalities of the blood vessels in the scrotum may appear to the physician as masses and need evaluation by ultrasound. A hydrocele, the most common cause of painless scrotal swelling, is a collection of fluid between two layers of tissue surrounding the testicle. An abnormal enlargement of the veins which drain the testicles is called a varicocele. It can cause discomfort and swelling, which can be examined by touch (palpated). Varicocele is a common cause of male infertility.

Precautions

Clear scrotal ultrasound images are difficult to obtain if a patient is unable to remain still.

Description

The patient lies on his back on an examining table. The technologist will usually take a history of the problem, then gently palpate the scrotum. A rolled towel is placed between the patient's legs to support the scrotum. The penis is lifted up onto the abdomen and covered. A gel that enhances sound transmission is put directly on the scrotum. The technologist then gently places a transducer (an electronic imaging device) against the skin. It is moved over the area creating images from reflected sound waves, which appear on a monitor screen. There is no discomfort from the study itself. However, if the scrotum is very tender, even the slight pressure involved may be painful.

Normal results

A normal study would reveal testicles of normal size and shape, with no masses.

Abnormal results

An abnormal result of an ultrasound of the scrotum may reveal an absent or undescended testicle, an inflammation problem, testicular torsion, a fluid collection, abnormal blood vessels, or a mass.

Key Terms

Hydrocele

A collection of fluid between two layers of tissue surrounding the testicle; the most common cause of painless scrotal swelling.

Varicocele

An abnormal enlargement of the veins which drain the testicles.

Further Reading

For Your Information

Books

• Leonhardt, Wayne C. "Scrotum." In Abdomen and Superficial Structures, 2nd ed., edited by Diane M. Kawamura. Philadelphia: Lippincott, 1997.

  Periodicals

• Bree, Robert L., and Dai T. Hoang. "Scrotal Ultrasound." Radiologic Clinics of North America, 34 (November 1996): 1183-1205.

Gale Encyclopedia of Medicine. Gale Research, 1999.